A Four-year Study of Anxiety, Depression, Loneliness, Social Support, and Perceived Mistreatment in Medical Students

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

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.

Medical Students' Experiences of Mistreatment by Clinicians and Academics at a South African University

Phenomenon: Tertiary education in post-apartheid South Africa has faced many challenges regarding class, language, and race. Even though previously white Afrikaans-rooted universities now have a diverse student population, recent student protests have highlighted the ongoing need for decolonization in higher education. In addition, the majority of public hospitals in the country function under significant staffing, infrastructure, and equipment shortages. Although the mistreatment of medical students has been well described internationally, to date no South African data exists. The aim of this study was to identify experiences of mistreatment of medical students by clinicians and academics at a South African university and to describe the type of mistreatment experienced, the perceived mental health effects, and the influence on academic performance, resilience, and students' knowledge of current reporting systems. Approach: A cross-sectional study was conducted through a locally developed online survey of 443 medical students at a South African university in May to June 2018, comprising of both open and closed ended questions. Levels of psychological distress (K10) and resilience (CD-RISC -10) were measured. Chi-square and student t-tests were used for the analysis of associations, and linear regressions were used to assess predictors of psychological distress. Qualitative data were analyzed thematically using the approach described by Braun and Clarke. Findings: Of 800 eligible medical students at Stellenbosch University, 443 students (55.4%) completed the survey. Mistreatment, comprising of being ignored/excluded (83.4%), offensive gestures (75.0%), verbal abuse (65.1%) and discrimination (64.4%), was prevalent and pervasive, and was perpetrated mainly by registrars (46.7%) and other medical staff (43.8%). Mistreatment was associated with psychological distress, which was generally high and more severe for females. Resilience, which was higher for males, moderated the effects of gender and perpetrator type on distress. Only 15% of students who had experienced mistreatment, either directly or indirectly, reported it, of which more than half (52.8%) were not happy with the outcome. Most students (80.9%) were not aware of the systems in place to report mistreatment. Insights: Student mistreatment is more highly prevalent among medical students at a South African university compared with studies conducted internationally. Despite over 20 years of democracy in South Africa, high rates of racial and gender discrimination were reported and descriptions of racial, language and gender discrimination were particularly concerning. Since the findings of this study, an anti-bullying poster-campaign has been initiated at the university as well as an online reporting system.

Mediating effect of family support on the relationship between acculturation and loneliness among the migrant elderly following children in Jinan, China

The total number of migrant elderly following children (MEFC) has gradually increased along with population aging and urbanization in recent decades in China. The purpose of this study was to investigate the mediating effect of family support on the relationship between acculturation and loneliness among the MEFC in Jinan, China. A total of 656 MEFC were selected by multistage cluster random sampling. Loneliness was measured using the short-form UCLA Loneliness Scale (ULS-8), while acculturation and family support were assessed using a self-designed questionnaire. Descriptive analysis, univariate analysis, and the structural equation model (SEM) were conducted to illustrate the relationship between the above indicators and loneliness. The average ULS-8 score of the MEFC was 12.82 ± 4.05 in this study. Acculturation of the MEFC exerted a negatively direct effect on loneliness and a positively direct effect on family support simultaneously, while family support exerted a negatively direct effect on loneliness. Family support partially mediated the relationship between acculturation and loneliness [95% CI: -0.079 to 0.013, p < 0.001], while the mediating effect of family support accounted for 14.0% of the total effect. The average ULS-8 score of 12.82 ± 4.05 implied a low level of loneliness in the MEFC in Jinan, China. Acculturation was found to be correlated with loneliness, while the mediating role of family support between acculturation and loneliness was established. Policy recommendations were provided to reduce loneliness and improve the acculturation and family support of the MEFC according to the findings above.

Bullying among undergraduate medical students at Tanta University, Egypt: a cross-sectional study

Introduction

Bullying is an aggressive behaviour that involves unwanted negative actions, which are repeated over time that can negatively impact a person.

Aim

To explore bullying behaviours experienced by Tanta University undergraduate students during their study in clinical medical education.

Methods

A cross-sectional study was conducted at Faculty of Medicine, during the period between first of October 2018 to end of May 2019. A stratified random sample was used to select medical students who rolled fourth-, fifth- and sixth-year classes at the academic year 2018–2019. Data were collected by a self-administered questionnaire included questions regarding demographic characteristics, history of exposure to different types of bullying and the response of bullied students.

Results

Findings of this study revealed that 71.1% of studied sample faced bullying during their medical study. The most frequently reported types were verbal (51.9%), behavioural (44.8%), being ignored (24.4%), written (17.8%) and physical (15.8%). About half of students (49.4%) were exposed to multiple forms of bullying. Male students were more exposed to physical, written and being ignored, whereas females were more witnessed to verbal and behavioural ones as follows: (30.7% vs 18.9% physical type, 72.5% vs 74.8% verbal, 28.1 vs 24.9% written, 57.9% vs 68.3% behavioural and 38.5% vs 32.4% being ignored), respectively. Fellow students (56.3%) were the most frequent perpetrators of mistreatment actions. The majority of students (91.3%) chose not to report bullying behaviours. Having mental health problems (0.00*) or disability (0.01*) were significantly more potential to experience mistreatment.

Discussion

Large proportion of medical students faced many forms of bullying.

Implications for Practice

Applying an effective policy to stop bullying with support for medical students may help to minimize this phenomenon.

Inadequate treatment in internships: a comparison between medical and other students

Aims: Inadequate treatment is one of the factors interfering with a successful social and working life. Among students, it can impair their health and learning progress. In the field of medicine the problem of inadequate treatment seems widespread. This study examines wether inadequate treatment in internships differs between medicine and other academic disciplines. Method: Using a questionnaire, the frequency, forms and severity of inadequate treatment among students were compared between the disciplines of medicine, civil engineering and teaching. Results: 69,3% of medical students reported inadequate treatment during their internships, about twice as many as students of other disciplines. The ratios of verbal, non-verbal and organisational inadequate treatment were similar between the different academic disciplines. However, medical students executed tasks without receiving sufficient safety precautions or training significantly more often (sevenfold) than students of other disciplines. In total however, the experienced incidents of inadequate treatment were seen as similarly severe across the different academic fields. Conclusion: Inadequate treatment of students during internships is a larger problem in medicine than in civil engineering or teaching, particularly concerning the performance of unsafe tasks. With regard to the health of students and patients, inadequate treatment in the medical education should be tackled. Previous studies suggest that this goal can be achieved only through longtime extensive measures on the level of students, lecturers, faculty and teaching hospitals.

A quarantined lodging stay: The buffering effect of service quality

How do guests feel during their stay at quarantine lodging? This study draws on terror management theory and social exclusion theory to synthesize a model that highlights guests' perceptions about their experience under enforced isolation. The model articulates guests' feeling of anxiety and loneliness, whereas quality of service presents warmth and care that activates an anxiety buffer mechanism that mitigates the effect of anxiety. In turn guests' level of anxiety is further explained by an interaction between their health status and the length of stay. Results point to a conduit for studying the dark side of hospitality, opening up research avenues that could help assess broader social behavioral changes during the global pandemic, while offering operators revelations for lodging management during a crisis.

Measuring exposure to bullying and harassment in health professional students in a clinical workplace environment: Evaluating the psychometric properties of the clinical workplace learning NAQ-R scale

Background: Instruments that measure exposure to bullying and harassment of students learning in a clinical workplace environment (CWE) that contain validity evidence are scarce. The aim of this study was to develop such a measure and provide some validity evidence for its use.Method: We took an instrument for detecting bullying of employees in the workplace, called the Negative Acts Questionnaire - Revised (NAQ-R). Items on the NAQ-R were adapted to align with our context of health professional students learning in a CWE and added two new factors of sexual and ethnic harassment. This new instrument, named the Clinical Workplace Learning NAQ-R, was distributed to 540 medical and nursing undergraduate students and we undertook a Confirmatory Factor Analysis (CFA) to investigate its construct validity and factorial structure.Results: The results provided support for the construct validity and factorial structure of the new scale comprising five factors: workplace learning-related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying (PIB), sexual harassment (SH), and ethnic harassment (EH). The reliability estimates for all factors ranged from 0.79 to 0.94.Conclusion: This study provides a tool to measure the exposure to bullying and harassment in health professional students learning in a CWE.

The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis

Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2–38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety—a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.

Factors Associated with Depression and Anxiety Symptoms Among Medical Students in Bahrain

OBJECTIVES

Medical training can be a stressful experience and may negatively impact mental health for some students. The purpose of this study was to identify the prevalence of depressive and anxiety symptoms among medical students in one international medical university in the Kingdom of Bahrain and to determine associations between these symptoms, the students' characteristics, and their satisfaction with life.

METHODS

This is a cross sectional study using a self-administered questionnaire, distributed to 350 enrolled medical students. We used Beck's Depression Inventory (BDI-II) and Beck's Anxiety Inventory (BAI) instruments to assess depressive and anxiety symptoms. The Satisfaction With Life Scale (SWLS) was used to measure global cognitive judgments of one's life satisfaction. Sociodemographic details including social background and academic information were also documented.

RESULTS

Forty percent (n = 124) of the participants had depressive symptoms, of which 18.9% (n = 58) met the criteria for mild, 13% (n = 40) for moderate, and 8.5% (n = 26) for severe depressive symptoms. Depressive symptoms were associated with Arab ethnicity (χ ² = 5.66, p = .017), female gender (χ ² = 3.97, p = .046), relationship with peers (p < .001), year of study (χ ² = 13.68, p = .008), and academic performance (p < 0.001). Anxiety symptoms were present in 51% (n = 158) of students. Anxiety symptoms were associated with female gender (χ ² = 11.35, p < 0.001), year of study (χ ² = 10.28, p = .036), and academic performance (χ ² = 14.97, p = .002).

CONCLUSION

The prevalence of depressive and anxiety symptoms among medical students was high. Medical universities in the Middle East may need to allocate more resources into monitoring and early detection of medical student distress. Medical education providers are encouraged to provide adequate pastoral and psychological support for medical students, including culturally appropriate self-care programs within the curriculum.

Social support and common mental disorder among medical students

INTRODUCTION

Different kinds of psychological distress have been identified for students in the health field, especially in the medical school.

OBJECTIVE

To estimate the prevalence of mental suffering among medical students in the Southeastern Brazil and asses its association with social support.

METHODS

It is a cross-sectional study. Structured questionnaires were applied for students from the 1st up to the 6th years of the medical school of Universidade Estadual Paulista "Júlio de Mesquita Filho", assessing demographic variables related to aspects of graduation and adaptation to the city. Psychological suffering was defined as a common mental disorder (CMD) assessed by the Self Reporting Questionnaire (SRQ-20). Social support was assessed by the social support scale of the Medical Outcomes Study (MOS). The association between the outcome and explanatory variables was assessed by the χ2 test and Logistic Regression, for the multivariate analyses, using p < 0.05.

RESULTS

The response rate was of 80.7%, with no differences between sample and the population regarding gender (p = 0.78). The average age was 22 years old (standard deviation - SD = 2.2), mainly women (58.2%) and students who were living with friends (62%). The prevalence of CMD was 44.9% (95%CI 40.2 - 49.6). After the multivariate analyses, the explanatory variables that were associated with CMD were: feeling rejected in the past year (p < 0.001), thinking about leaving medical school (p < 0.001) and "interaction" in the MOS scale (p = 0.002).

CONCLUSIONS

The prevalence of CMD among medical students was high and insufficient social support was an important risk factor. Our findings suggest that interventions to improve social interaction among those students could be beneficial, decreasing the prevalence of CMD in this group.

The relationships between empathy, stress and social support among medical students

OBJECTIVE

To examine the relationship between stress, social support, and empathy among medical students.

METHODS

We evaluated the relationships between stress and empathy, and social support and empathy among medical students. The respondents completed a questionnaire including demographic information, the Jefferson Scale of Empathy, the Perceived Stress Scale, and the Multidimensional Scale of Perceived Social Support. Correlation and linear regression analyses were conducted, along with sub-analyses according to gender, admission system, and study year.

RESULTS

In total, 2,692 questionnaires were analysed. Empathy and social support positively correlated, and empathy and stress negatively correlated. Similar correlation patterns were detected in the sub-analyses; the correlation between empathy and stress among female students was negligible. In the regression model, stress and social support predicted empathy among all the samples. In the sub-analysis, stress was not a significant predictor among female and first-year students.

CONCLUSIONS

Stress and social support were significant predictors of empathy among all the students. Medical educators should provide means to foster resilience against stress or stress alleviation, and to ameliorate social support, so as to increase or maintain empathy in the long term. Furthermore, stress management should be emphasised, particularly among female and first-year students.

Social support mediates loneliness and depression in elderly people

This study investigated the effect of loneliness on depression and further tested the mediating effect of social support. A total of 320 elderly persons completed the Emotional and Social Loneliness Scale, Multidimensional Scale of Perceived Social Support, and Self-Rating Depression Scale. Results revealed that loneliness and social support significantly correlated with depression. Structural Equation Modeling indicated that social support partially mediates loneliness and depression. The final model illustrated a significant path from loneliness to depression through social support. This study sheds light on the concurrent effects of loneliness and social support on depression, providing evidence on how to reduce depression among the elderly.

Communication competence, social support, and depression among college students: a model of facebook and face-to-face support network influence

This study examined the influence of the social networking site Facebook and face-to-face support networks on depression among (N = 361) college students. The authors used the Relational Health Communication Competence Model as a framework for examining the influence of communication competence on social support network satisfaction and depression. Moreover, they examined the influence of interpersonal and social integrative motives as exogenous variables. On the basis of previous work, the authors propose and test a theoretical model using structural equation modeling. The results indicated empirical support for the model, with interpersonal motives predicting increased face-to-face and computer-mediated competence, increased social support satisfaction with face-to-face and Facebook support, and lower depression scores. The implications of the findings for theory, key limitations, and directions for future research are discussed.

Health-related quality of life of medical students

OBJECTIVES

Mental problems such as stress, anxiety and depression have been described among medical students and are associated with poor academic and professional performance. It has been speculated that these problems impair students' quality of life (QoL). The authors aimed to assess the health-related QoL (HRQL) of medical students throughout their 6 years of training at a school with a traditional curriculum.

METHODS

Of a total of 490 students attending our institution's medical school, 38 were surveyed in February 2006 (incoming Year 1 group, surveyed when students were in the second week of Year 1 classes) and 352 were surveyed in February 2007 (students in Years 1-6). Students self-reported their HRQL and depressive symptoms using the Short-Form Health Survey (SF-36) and the Beck Depression Inventory (BDI). Comparisons were performed according to year in training, presence of depressive symptoms, gender, living arrangements and correlations with family income.

RESULTS

The students' ages ranged from 18 to 31 years (median 22.3 years). Students in Years 2, 3, 4 and 6 had lower scores for mental and physical dimensions of HRQL compared with the incoming Year 1 group (P < 0.01), with the largest difference observed for Year 3 students. Students with depressive symptoms had lower scores in all domains of the SF-36 (P < 0.01). Female students had lower HRQL scores than males (P < 0.01). No differences were observed for students living with versus without family and no correlation with family income was found.

CONCLUSIONS

Major impairments in HRQL were observed among Year 3 students, students with depressive symptoms and women. Medical schools should institute efforts to ensure that students' HRQL and emotional support are maintained, particularly during critical phases of medical training.

Temporal structure of first-year courses and success at course exams: comparison of traditional continual and block delivery of anatomy and chemistry courses

AIM

To evaluate students' academic success at delivered in a traditional continual course, spread over the two semesters, or in alternating course blocks.

METHOD

We analyzed the data on exam grades for Anatomy and Chemistry courses in the first year of the curriculum for academic year 2001/02, with the traditional continual delivery of the courses (n=253 for chemistry and n=243 for anatomy), and academic year 2003/04, with block delivery of the courses (n=255 for Chemistry and n=260 for Anatomy). Grades from the final examination were analyzed only for students who sat the exam at the first available exam term and passed the course. For the Anatomy block course, grades at 2 interim written tests and 2 parts of the final exam (practical stage exam and oral exam) in each block were analyzed for students who passed all interim tests and the final exam.

RESULTS

There were no differences between two types of course delivery in the number of students passing the final examination at first attempt. There was a decrease in passing percentage for the two Anatomy block course student groups in 2003/04 (56% passing students in block 1 vs 40% in block 2, P=0.014). There was an increase in the average grades from 2001/02 to 2003/04 academic year due to an increase in Chemistry grades (F1,399=18.4, P<0.001, 2 x 2 ANOVA). There was no effect of the sequence of their delivery (F1,206=1.8, P=0.182, 2 x 2 ANOVA). There was also a significant difference in grades on interim assessments of Anatomy when it was delivered in the block format (F3,85=28.8, P<0.001, between-within subjects 2 x 4 ANOVA).

CONCLUSIONS

The type of course delivery was not associated with significant differences in student academic success in Anatomy and Chemistry courses in the medical curriculum. Students can successfully pass these courses when they are delivered either in a continual, whole year format or in a condensed time format of a course block, regardless of the number and type of courses preceding the block course.

Student-led stress management program for first-year medical students

BACKGROUND

The medical education community has emphasized repeatedly the importance of teaching stress management and self-care skills to medical students. However, descriptions and evaluations of intervention programs are infrequent. This article describes a student-led stress management program for 1st-year medical students and summarizes program evaluation data from 1,111 participants.

DESCRIPTION

The Stress Management Program is a voluntary activity that involves small groups of 1st-year medical students meeting with 2nd-year student coleaders. At the beginning of the fall semester, each group meets 1 hr per week for 7 consecutive weeks. Two psychologist faculty members serve as program coordinators.

EVALUATION

Mean annual participation rate for 1st-year students was 94% over 16 years. Program evaluation results are strongly positive.

CONCLUSIONS

Based on longevity, participation, and student feedback, the program has been successful. Recommendations for creating and maintaining similar programs are offered.

Improving response rates: introducing an anonymous longitudinal survey research protocol for veterinary medical students

With the Journal of Veterinary Medical Education's recent summer 2005 theme issue on stress, the mental-health concerns of veterinary medical students has been brought to the forefront of the field. Since it is anticipated that research on this topic will continue and that educational institutions may implement changes based upon these results, it is of the utmost importance that this research be of the highest quality. Of particular concern with human-subject inquiries are response rates and confidentiality. In order to accommodate these concerns, an example of a survey research protocol that promotes high response rates and minimizes threats to internal validity influenced by student mistrust in assurances of confidentiality is presented. Specifically, the protocol is designed to ensure anonymity and to preserve the ability to track students longitudinally through the use of anonymous longitudinal identifiers. This protocol was tested with the first-year class of veterinary medical students at Kansas State University in October 2004 and March 2005. The two data collection periods yielded 90% and 76% response rates, respectively. The matching rate of participants, according to the anonymous longitudinal identifiers from Time 1 to Time 2, was 88%.

Student-led stress management program for first-year medical students

BACKGROUND

The medical education community has emphasized repeatedly the importance of teaching stress management and self-care skills to medical students. However, descriptions and evaluations of intervention programs are infrequent. This article describes a student-led stress management program for 1st-year medical students and summarizes program evaluation data from 1,111 participants.

DESCRIPTION

The Stress Management Program is a voluntary activity that involves small groups of 1st-year medical students meeting with 2nd-year student coleaders. At the beginning of the fall semester, each group meets 1 hr per week for 7 consecutive weeks. Two psychologist faculty members serve as program coordinators.

EVALUATION

Mean annual participation rate for 1st-year students was 94% over 16 years. Program evaluation results are strongly positive.

CONCLUSIONS

Based on longevity, participation, and student feedback, the program has been successful. Recommendations for creating and maintaining similar programs are offered.

Is the introduction of a student-centred, problem-based curriculum associated with improvements in student nurse well-being and performance? An observational study of effect

AIMS

To explore the impact of curriculum redesign and innovation on student well-being and performance, including essay and examination marks and sickness absence.

BACKGROUND

While the emotional impact of preparing to be a health professional can be reduced by helping students to adapt, the positive effect of curriculum innovation and redesign is rarely evaluated. DESIGN, SAMPLE AND METHODS: Student nurse well-being and performance was compared at weeks 24/25 and 40/50 following course entry between comparable independent cohorts of students undertaking a traditional programme (N=406, 83% return rate) with those on an innovative, student-centred, problem-based educational programme (N=447, 79% return rate). The setting was a School of Nursing and Midwifery in the North-East of Scotland. Measures included stress and mental health outcomes and measures of performance including academic marks and sickness absence.

RESULTS

At week 25 into the course students on the innovative course had fewer academic, clinical and personal worries than students in the previous more traditional programme and were more likely to report using adaptive direct, problem-solving coping at week 50. While students on the innovative course reported less distress in their first year of the course, they scored less well on comparable essay assignments and had reliably greater sickness absence totals than those educated by traditional methods.

CONCLUSION

In this setting, curriculum innovation was associated with positive changes in student well-being but not on performance.

Teaching research methodology in medical schools: students' attitudes towards and knowledge about science

OBJECTIVE

To explore the relationship between teaching scientific methodology in Year 2 of the medical curriculum and student attitudes towards and knowledge about science and scientific methodology.

DESIGN

Anonymous questionnaire survey developed for this purpose.

SETTING

Zagreb University School of Medicine, Croatia.

PARTICIPANTS

A total of 932 students (response rate 58%) from all 6 years were invited to participate.

MAIN OUTCOME MEASURES

Score on attitude scale with 45 Likert-type statements and score on knowledge test consisting of 8 multiple choice questions.

RESULTS

The average attitude score for all students was 166 +/- 22 out of a maximum of 225, indicating a positive attitude towards science and scientific research. The students' average score on the knowledge test was 3.2 +/- 1.7 on 8 questions. Students who had finished Year 2 had the highest mean attitude (173 +/- 24) and knowledge (4.7 +/- 1.7) scores compared with other year groups (P < 0.001, anova and Tukey posthoc test). For students who had attended a mandatory Year 2 course on the principles of scientific research in medicine (Years 3 to 6), multiple linear regression analysis showed that knowledge test score (B = 3.4; SE = 0.4; 95% confidence interval 2.5-4.2; P < 0.001) and average grades (B = 7.6; SE = 1.5; 95% CI 4.6-10.6; P < 0.001) were significant predictors of attitude towards science, but not sex or failure to pass a year (B = - 0.6; SE = 1.7; 95% CI - 3.9-2.6; P = 0.707; and B = - 3.1; SE = 1.9; 95% CI - 6.8-5.7; P = 0.097, respectively).

CONCLUSION

Medical students have generally positive attitudes towards science and scientific research in medicine. Attendance of a course on research methodology is related to a positive attitude towards science.

Factors affecting progress of Australian and international students in a problem-based learning medical course

CONTEXT

Research on the factors affecting progress in medical schools has typically focused on mainstream (non-Indigenous Australian, non-international) students in traditional, didactic programmes. These results may not be applicable to students, particularly those from culturally diverse backgrounds, undertaking problem-based learning courses.

OBJECTIVE

This study used qualitative methodology to explore and compare factors affecting progress for mainstream Australian students (non-Indigenous Australian, non-international) and international students (full fee-paying students who had relocated countries to study) in a problem-based learning medical course. Intervention strategies were devised on the basis of the participants' experiences.

METHODS

Six focus group discussions were conducted (three with mainstream Australian and three with international participants). Transcripts of these discussions were coded and analysed independently by two researchers and discussed until consensus was attained.

RESULTS

Participants identified both positive and negative experiences related to the course structure, which were consistent with previous findings. The participants' experiences demonstrated a relationship between sense of 'belongingness' to the medical school community, participation in learning opportunities and progress through the course.

CONCLUSIONS

The results suggest that interventions aimed at reducing barriers to progress need to promote students' confidence, motivation and subsequent participation in course learning opportunities. These results have application to other problem-based learning courses particularly those which face the challenge of providing an optimal learning environment for students from diverse backgrounds.