Psychosocial health risk factors and resources of medical students and physicians: a cross-sectional study

Academic climate and psychopathological symptomatology in Spanish medical students

INTRODUCTION

Medical Education studies suggest that medical students experience depression, anxiety and psychopathological symptomatology in a proportion higher than in the rest of the population. In the present study, we aimed to conduct a nationwide analysis to describe student's perceptions of Educational Climate in Spanish medical schools, and its relationship with psychopathological symptomatology.

METHODS

The study was carried out in 2022 in all 44 medical schools in Spain, and analyses the academic climate, and psychopathological symptomatology among medical students (n = 4374). To measure these variables, we used the Dundee Ready Education Environment Measure (DREEM) for academic climate, and the SA-45 (Symptom Assessment-45 Questionnaire was used to assess psychopathological symptomatology.

RESULTS

The mean DREEM global score was low, 95.8 (SD 22.6). Worse perception of the academic climate has been found in females (t -2.21, p 0.027), in students of the clinical academic years (t 16.9, p < 0.001), and public medical schools ( t 15.6, p < 0.001). The SA45 general index score was high (p90) in 25.6% of participants. In respect of gender, female students presented higher levels of SA45 general index score, depression, interpersonal sensitivity, somatization, anxiety, obsession-compulsion, and phobic anxiety symptoms. Higher DREEM global and subscale scores corresponded to a higher SA-45 global index score and higher SA-45 subscale scores.

CONCLUSIONS

Our study suggests a correlation between a poor perception of academic climate, increased depression, anxiety, and other psychopathological symptoms, with a pattern that varies between different faculties. The perception of academic climate varied between medical schools, as did the psychopathological symptoms scores. Our finding suggests the prevalence of these variables in medical students is, at least in part, attributable to factors directly related to the learning atmosphere.

Vulnerable in the end - Longitudinal study among medical students on mental health and personal and work-related resources over a 5.5-year-period

BACKGROUND

Mental health problems are common in medical professionals and their development already starts at the undergraduate level. Studies on medical students can replicate higher prevalence for depression and burnout in this group, but they normally compare semester cohorts in an anonymized, cross-sectional approach and without a preventive perspective.

METHODS

We surveyed medical students at the beginning and end of their medical curriculum and collected data on burnout, depressivity, work related experience and salutogenesis parameters with validated self-administered questionnaires. Most remarkably we obtained the data from the same 58 individuals after 5.5 years, representing data of the highest quality in order to compare the mental health status at the beginning and the end of our students´ medical curriculum.

RESULTS

Our results not only show a severe exacerbation of physical, mental and emotional burnout in the participants at the end of their studies. The students also do not seem to have sufficient personal (resilience) or social resources (e.g. experience of social support) for coping with their mental health problems around the time of their graduation.

CONCLUSIONS

Our participants reflect a development of mental health during their medical studies at university that is paving the way to the devastating prevalence of mental disorders and suicide in health professionals. From our results we derive an urgent need to integrate self-care and active coping in the learning goals of medical curricula.

Screen time and sleep among medical students in Germany

Medical students are a vulnerable group for harmful health behaviours due to academic stress. Increased screen time is associated with adverse health behaviour, particularly delayed bedtime, shorter sleep duration and poorer sleep quality. This possible relationship has not yet been examined among medical students in Europe. Medical students at the Technical University of Dresden were invited to participate in an online questionnaire based cross-sectional study. To analyse correlations between screen time and sleep parameters, correlation coefficients, linear regression and mixed-model analysis were calculated. 415 students (average age 24 years, 70% female) were included in the analysis. The students reported an average of 7 h screen time per day and 7.25 h sleep duration per night. Approximately 23% (n = 97) reported sleeping less than 7 h per night and 25% (n = 105) reported fairly to very poor sleep quality. Students who reported more screen time for leisure went to bed significantly later (r = 0.213, p < 0.001). Students who spent more screen time for study/work tended to sleep shorter (r = - 0.108, p < 0.015). There was no significant association between screen time and sleep quality (p = 0.103). The results show a need for educational interventions to promote healthy sleep behaviour and to limit screen time.

The role of chronic physical illness and job dissatisfaction on burnout’s risk among medical interns in Oman: a study of prevalence and determinants

Background

Medical interns are at risk of burnout due to several organizational and individual factors. There is scarcity of studies exploring the role of chronic physical illness and job dissatisfaction on burnout experience among medical interns. This study examined the prevalence of burnout syndrome and explored whether chronic physical illness and job dissatisfaction could independently predict burnout syndrome among medical interns in Oman. This cross-sectional study was conducted among a random sample of medical interns enrolled in the Omani internship program. One-hundred and eighty interns participated in this study and filled in a self-reported questionnaire that included Maslach Burnout Inventory (MBI), Job Satisfaction Survey (JSS), and data related to physical illness.

Results

The prevalence of burnout syndrome was 15%. Having a physical illness (OR = 7.285, 95% CI = 1.976–26.857, P = 0.003) and job dissatisfaction (OR = 16.488, 95% CI = 5.371–50.614, P = 0.0001) was significant independent predictors of high levels of the EE subscale. In addition, having a physical illness (OR = 4.678, 95% CI = 1.498–14.608, P = 0.008) and being dissatisfied (OR = 2.900, 95% CI = 11.159–7.257, P = 0.023) were significant independent predictors of the high DP subscale. Having physical illness was independent predictors of the low personal accomplishment subscale (OR = 0.258, 95% CI = 0.088–0.759, P = 0.014).

Conclusions

Burnout syndrome is prevalent among medical interns in Oman. Job dissatisfaction and chronic physical illness are risk factors for burnout syndrome. Internship programs should consider these factors when designing burnout mitigative strategies.

The Impact of University-Related Variables on Students’ Perceived Employability and Mental Well-Being: An Italian Longitudinal Study

The COVID-19 outbreak has had a disruptive impact on the academic context and labor market. Indeed, the pandemic shock in such fields has been related to several changes with implications for young people’s careers and well-being. This two-wave longitudinal study, conducted in Italy, aimed to explore the predictiveness of some individual and organizational factors on students’ perceived employability and well-being. A total of 301 Italian students, aged between 18 and 33 (M = 20.63, SD = 1.99), completed a self-report questionnaire measuring career ambition, university reputation, university commitment, technostress related to technology-enhanced learning, perceived employability, and mental well-being at both time points. A path analysis showed that career ambition, university reputation, and organizational commitment positively predicted employability, which, in addition to such variables, positively affected well-being. In contrast, technostress was identified as a risk factor both for students’ perceptions of finding a job and for their well-being. These findings provide a theoretical contribution to a better understanding of the factors involved in undergraduates’ perceived employability and well-being. Moreover, they suggest the need to improve academic-related variables to enhance individuals’ resources in coping with the pandemic challenges.

Influences of Occupational Burnout and Personality on Lipid Peroxidation Among Nurses in Shahroud City, Iran

Considering the relationship between occupational burnout and oxidative stress, identifying the factors that affect occupational burnout, such as recognizing individual characteristics, would be beneficial for implementing strategies to reduce oxidative stress levels. This study was conducted on 92 nurses from a hospital in Shahroud, a city in northeastern Iran, who were chosen at random. The data was collected through the Demographic Questionnaire, Maslach Burnout Inventory and Personality Factors Inventory. Each participant's serum markers of oxidative stress were also measured. Total antioxidant capacity (TAC) and neuroticism were found to have a negative relationship in this study. Furthermore, marital status, the ward where nurses work, the type of contract, emotional exhaustion, and depersonalization were all found to be significant predictors of malondialdehyde (MDA). Neuroticism, emotional exhaustion, and depersonalization were the most important predictors of oxidative stress levels.The results of this study suggest that some approaches to reducing oxidative stress can be implemented by identifying the factors influencing occupational burnout and also by recognizing individuals' personality traits.

Impact of exemplar education program on the professional commitment of nursing students: A quasi-experimental study

BACKGROUND

High attrition rate and nursing workforce shortage have been a prevailing world challenge. Professional commitment is a known key factor for attracting and retaining the nursing workforce.

OBJECTIVE

To design, implement and evaluate the impact of a one-week structured education program, underpinned by the exemplar education strategy, on the professional commitment of undergraduate nursing students.

DESIGN

A quasi-experimental study was designed with pre- and post-intervention measurements. The intervention was a structured, four module education program underpinned by the exemplar education strategy.

SETTING

Department of Nursing, Qianjiang College, Hangzhou Normal University, Zhejiang, China.

PARTICIPANTS

152 third-year nursing students who attended the education program and consented to participate were enrolled in the research.

METHODS

The intervention, the education program, was delivered over 16 h in one week of an 18-week semester. It was sequenced in four modules: expert lectures (3 h each), visiting a hospital (3 h), alumni salon (3 h), and submitting a reflection report (4 h). Professional commitment was measured by the Nursing Professional Commitment Scale (NPCS) administered both pre- and post-intervention.

RESULTS

The total professional commitment measurement score was significantly improved after the intervention. There were statistically significant differences before and after intervention in the four dimensions of professional commitment, namely, belief in goals and values, willingness to make an effort, desire to stay in the profession, and intrinsic positive value of work.

CONCLUSION

The one-week professional education program underpinned by the exemplar education strategy effectively improved the level of professional commitment of the undergraduate nursing students. The program can be transferred into the curriculum to improve nursing students' professional commitment. The methodology can be applied in other aspects of nursing professional development.

Fostering learning capacities for meaningful, healthy and efficient studying in undergraduate medical education: evaluation of a longitudinal learning workshop

BACKGROUND

Academic studies place high demands on the development of learning capacities. Beyond learning techniques, knowledge about the effect of the learning environment, as well as the ability for self-regulation, self-determination and self-care play a major role in the development of learning skills. A longitudinal learning workshop was developed aiming to support academic learning life. The study at hand describes and evaluates this intervention.

METHODS

Students participated in a seven-week program fostering reflection and training on physical, physiological, psychological and mental dimensions of learning. Fifty evaluations of medical students reflecting the workshop underwent qualitative analysis of open-ended questions concerning changes students experienced in their learning life. In addition, general satisfaction was measured quantitatively.

RESULTS

Qualitative results revealed an impact on five core dimensions of students´ learning life: knowledge gained about the process of learning, enhanced awareness of intrapersonal learning processes, getting easier into action, experience of change and raised skills of regulating one´s learning behavior. Students evaluate the workshop as helpful, supportive and as a source of guidance. Quantitative results demonstrated good overall satisfaction with the intervention.

CONCLUSIONS

Educating knowledge about learning how to learn and providing skill training of how to regulate physiology, psychology and mentality should be taken into account in order to support the multidimensional learning life of students. Using a holistic, anthropologically grounded approach could be considered to enhance healthy, meaningful and efficient ways of learning. This learning workshop seems to be a useful and transferable tool to support students' development of learning capacities.

Stress and behavior patterns throughout medical education - a six year longitudinal study

BACKGROUND

Medical education has a reputation for being demanding and stressful. However, longitudinal surveys across the whole course of study considering risks and resources are rare.

METHODS

For the evaluation of stress and coping we administered the standard instruments Perceived Medical School Stress Scale (PMSS), Hospital Anxiety and Depression Scale (HADS), Work-Related Behavior and Experience Patterns (AVEM), Maslach Burnout Inventory (MBI), and a short form of the Coping Orientations to Problems Experienced Scale (Brief COPE) in three consecutive cohorts of medical students (N = 377) at one German university. Students were surveyed at the beginning of their studies (t0) and again during each consecutive summer semester (t1-t6).

RESULTS

Stress and symptoms of anxiety and depression increased in the first two years of medical studies but decreased again towards their end. Consistently, freshmen medical students presented with a large proportion of the healthy pattern at t0 (56 %) that decreased to 30 % at t2, and increased up to 44 % at t6. Correspondingly, the proportion with the burnout-related risk pattern B increased from 9 to 16 % at t2, again decreasing to 7 % at t6. Over the whole course of study there was an almost continuous increase of the unambitious pattern S from t0 13 to 40 % at t6. Characteristic differences especially between the healthy pattern and the risk patterns regarding stress, mental health symptoms and coping were observed. Female students showed a higher vulnerability for stress, anxiety and depression as well as lower proportions with a healthy pattern, and higher proportions with risk patterns for overexertion and burnout.

CONCLUSIONS

The development of stress, symptoms and behavior and experience patterns especially in the first two years, demonstrating increasing study-related stress in the preclinical years, as well as the high proportion with an unambitious pattern at the end of the course of study emphasize the need for prevention and health promotion at both the individual and contextual levels.

Effectiveness of a Mindfulness-Based Programme on Perceived Stress, Psychopathological Symptomatology and Burnout in Medical Students

OBJECTIVES

Medical students display a high prevalence of psychopathological symptomatology, stress and burnout, which may continue in their time as resident and fully qualified doctors. The aim of this study is to evaluate and compare the effects of a mindfulness-based programme on these variables in an experimental group of medical students who underwent the intervention programme compared to a control group who did not.

METHODS

A quasi-experimental study of two independent groups (experimental and control) with two repeated measures (pre and post) was performed. Eight sessions of 2-h duration each were held over the course of 16 weeks. A total of 143 students participated in the study, 68 in the intervention group and 75 in the control group. A sociodemographic questionnaire was administered along with the Symptom Checklist-90-R (SCL-90-R), the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory-Student Survey (MBI-SS).

RESULTS

Our study revealed a clear improvement compared to the control group in perceived stress and psychopathological symptomatology, in the Global Severity Index, Positive Symptom Total and the primary symptom dimensions of somatization, obsessive compulsive, interpersonal sensitivity and anxiety of the SCL-90-R. The improvement was significant at both intra- and intergroup level. No impact was found on the level of burnout.

CONCLUSIONS

The mindfulness-based programme that was used resulted in an improvement in psychopathological symptomatology and stress, with no effect observed on BO score. This study can contribute to the design of a training programme to promote effective self-care and stress management strategies for both medical students and doctors.

Effect of flipped classroom methodology on the student performance of gastrointestinal and renal physiology entrants and repeaters

BACKGROUND

Physiology is a subject that is considered difficult; it is associated with academic failure and causes high levels of stress and anxiety in students.

METHODS

This study compared the effectiveness of a traditional lecture-based methodology with that of a flipped classroom scheme focusing on cooperative ludic learning among gastrointestinal and renal physiology students. Two groups were subjected to these two different methods to teach gastrointestinal and renal physiology content divided into 14 topics. Additionally, two subgroups were identified in each group: entrants and repeaters. There were no differences in age or gender between the subgroups.

RESULTS

Levels of self-perceived stress (measured by the SISCO scale), biological stress (measured by awakening salivary cortisol levels), and anxiety (measured by the Zung scale) were high in all of the students; the cortisol levels increased in the entrants and some of the scores in SISCO scale increased in the repeaters, throughout the study. The self-reported study time was longer in the students subjected to the flipped classroom-based method. The final exam results were better only in the new students facing the flipped methodology, but not in the repeaters, who scored lower on the final evaluation. The quantitative and qualitative assessments completed by the participants regarding the different aspects of the flipped-classroom-based methodology were favorable; however, the participants believed that traditional lectures should be maintained for specific topics.

CONCLUSIONS

A methodology based on flipped teaching was an effective strategy to improve academic performance ingastrointestinal and renal physiology, but only in new students.

Study-related behavior patterns of medical students compared to students of science, technology, engineering and mathematics (STEM): a three-year longitudinal study

BACKGROUND

Medical education is perceived as demanding and stressful. Whether this is particularly pronounced in this course of study remains under debate.

METHODS

We used the questionnaire "Work-Related Behavior and Experience Patterns (Arbeitsbezogene Verhaltens- und Erlebensmuster (AVEM))" to assess the development of study-related behavior and experience patterns in medical (n = 584) and STEM students (n = 757) at one German university, with a special emphasis on gender differences, over 3 years of study. Students were surveyed at the beginning of their studies (t0) and again in each consecutive summer semester (t1-t3). Both cross-sectional and longitudinal data were generated and analyzed. Results in the abstract are from the cross-sectional analysis.

RESULTS

Freshman medical students presented with a larger proportion of students with a healthy pattern (58.1%) than STEM students (42.5%). In both groups this proportion decreased to 33.8%/25.1% at t2, with only a minor improvement at t3 (38.1/27.0%). Correspondingly, the proportion of students with a burnout-related risk pattern increased from 8.0% (Med)/13.7% (STEM) to a maximum of 16.9% at t2 in medical students and 27.0% at t3 in STEM students. In both groups female students showed a more unfavorable distribution of patterns and a higher vulnerability, especially in the area of resistance toward stress.

CONCLUSIONS

The unfavorable development of behavior and experience patterns in both student groups demonstrates increasing study related stress and emphasizes the need for prevention and health promotion on an individual and a contextual level.

Professional burnout among medical students: Systematic literature review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aim to summarize the available evidence on the prevalence of professional burnout among medical students.

METHODS

The review was performed according to the PRISMA guidelines. Databases were systematically searched for peer-reviewed articles, reporting burnout among medical students published between 2000 and 2017. The meta-analysis was conducted on the available data on burnout rates in medical students measured with the Maslach Burnout Inventory (MBI-HSS).

RESULTS

Fifty-eight out of 3006 studies were found eligible for inclusion. Twelve of these studies met the criteria for meta-analysis. Weighted mean values for the three sub-dimensions of the MBI-HSS were M = 22.93 (SD = 10.25) for Emotional Exhaustion, M = 8.88 (SD = 5.64) for Depersonalization, and M = 35.11 (SD = 8.03) for Personal Accomplishment. Prevalence rates for professional burnout ranged from 7.0% to 75.2%, depending on country-specific factors, applied instruments, cutoff-criteria for burnout symptomatology.

CONCLUSION

This review underlines the burden of burnout among medical students. Future research should explicitly focus on specific context factors and student group under investigation. Such efforts are necessary to control for context-dependent confounders in research on medical students' mental health impairment to enable more meaningful comparisons and adequate prevention strategies.

Determinants of burnout syndrome among nurses in Cameroon

Objectives

Burnout syndrome is common amongst medical personnel. The objective of this study was to identify determinants of burnout syndrome among nurses in the north west and south west regions of Cameroon.

Results

A cross-sectional analysis during the months of January–June 2018 was carried out recruiting nurses consecutively after consent from state-owned and private hospitals in the English-speaking regions of Cameroon. Burnout was assessed using the Oldenburg Burnout Inventory (OLBI). Univariable regression analysis used to identify determinants of burnout syndrome among 143 nurses (mean age 29.75 ± 6.55 years) showed that being in a personal relationship (Beta = 2.25) significantly explained 3.8% of the variation in burnout (R² = 3.8, F (1, 125) = 4.89, p = 0.029).

Electronic supplementary material

The online version of this article (10.1186/s13104-018-4004-3) contains supplementary material, which is available to authorized users.

Differences of Four Work-Related Behavior and Experience Patterns in Work Ability and Other Work-Related Perceptions in a Finance Company

The present study applies a salutogenetic approach to psycho-social stress and wellbeing at work and for the first time analyzes the relation of an extended model of four work-related behavior and experience patterns to work related perceptions, like work ability, job satisfaction and turnover intention, or engagement. Employees of an international financial services company (N = 182) completed the questionnaire Work-related behavior and experience pattern (Arbeitsbezogenes Verhaltens- und Erlebensmuster; AVEM). The AVEM has oftentimes been used for research in helping professions, but research in non-helping professions is scarce. In addition to the AVEM, measures of job satisfaction, work ability, work engagement, presenteeism, and turnover intention were included in this study. Almost half (46.2%) of the sample showed a rather unambitious attitude towards work, followed by a burnout-related risk pattern (22.0%), a healthy pattern (19.8%), and a pattern at risk for overexertion (12.1%). Significantly more favorable scores were found for all work-related perceptions in participants with the healthy pattern compared to those with the burnout-related risk pattern, except for turnover intention where no significant differences were found. For work ability and vigor, those with a healthy pattern also had significantly higher scores than those with an unambitious pattern and a pattern at risk for overexertion. Being at risk for burnout not only affects job-related wellbeing and coping resources, but also work ability and work engagement. A need for personnel and organizational development and health promotion is indicated by a high number of individuals with reduced working motivation and risk patterns for overexertion or burnout.

Perceived Social Support as a Determinant of Quality of Life Among Medical Students: 6-Month Follow-up Study

OBJECTIVE

This longitudinal study aimed to identify the relevant factors related to quality of life (QoL) changes in medical students.

METHODS

For this 6-month follow-up study, we enrolled 109 students from a Korean medical school. To assess students' QoL, we used the World Health Organization QoL scale. Possible determinants of student QoL included demographics, fatigue, and social support. A stepwise multivariate analysis identified factors associated with changes of student QoL.

RESULTS

Among sources of support, the "friends" category was the main position affecting their overall QoL, and "significant other" had the strongest influence on psychological and social domains. The impact of support from friends on QoL was confirmed in the longitudinal analysis. Final regression models revealed that providing students with more social support and promoting fatigue reduction best improved medical student sense of well-being.

CONCLUSION

Creating stronger student support programs to prevent social detachment and implementing strategies to reduce fatigue can improve QoL in medical students.

Coping with stress in medical students: results of a randomized controlled trial using a mindfulness-based stress prevention training (MediMind) in Germany

BACKGROUND

High prevalence rates of psychological distress in medical training and later professional life indicate a need for prevention. Different types of intervention were shown to have good effects, but little is known about the relative efficacy of different types of stress management interventions, and methodological limitations have been reported. In order to overcome some of these limitations, the present study aimed at evaluating the effect of a specifically developed mindfulness-based stress prevention training for medical students (MediMind) on measures of distress, coping and psychological morbidity.

METHODS

We report on a prospective randomized controlled trial with three study conditions: experimental treatment (MediMind), standard treatment (Autogenic Training) and a control group without treatment. The sample consisted of medical or dental students in the second or eighth semester. They completed self-report questionnaires at baseline, after the training and at one year follow-up. Distress (Trier Inventory for the Assessment of Chronic Stress, TICS) was assessed as the primary outcome and coping (Brief COPE) as a co-primary outcome. Effects on the psychological morbidity (Brief Symptom Inventory, BSI) as a secondary outcome were expected one year after the trainings.

RESULTS

Initially, N = 183 students were randomly allocated to the study groups. At one year follow-up N = 80 could be included into the per-protocol analysis: MediMind (n =31), Autogenic Training (n = 32) and control group (n = 17). A selective drop-out for students who suffered more often from psychological symptoms was detected (p = .020). MANCOVA's on TICS and Brief COPE revealed no significant interaction effects. On the BSI, a significant overall interaction effect became apparent (p = .002, η2partial = .382), but post hoc analyses were not significant. Means of the Global Severity Index (BSI) indicated that MediMind may contribute to a decrease in psychological morbidity.

CONCLUSION

Due to the high and selective dropout rates, the results cannot be generalized and further research is necessary. Since the participation rate of the trainings was high, a need for further prevention programs is indicated. The study gives important suggestions on further implementation and evaluation of stress prevention in medical schools.

TRIAL REGISTRATION

This trial is recorded at German Clinical Trials Register under the number DRKS00005354 (08.11.2013).

Mental Well-Being in First Year Medical Students: A Comparison by Race and Gender: A Report from the Medical Student CHANGE Study

PURPOSE

In this study, authors sought to characterize race and gender disparities in mental health in a national sample of first year medical students early in their medical school experience.

METHOD

This study used cross-sectional baseline data of Medical Student CHANGES, a large national longitudinal study of a cohort of medical students surveyed in the winter of 2010. Authors ascertained respondents via the American Association of Medical Colleges questionnaire, a third-party vendor-compiled list, and referral sampling.

RESULTS

A total of 4732 first year medical students completed the baseline survey; of these, 301 were African American and 2890 were White. Compared to White students and after adjusting for relevant covariates, African American students had a greater risk of being classified as having depressive (relative risk (RR)=1.59 [95 % confidence interval, 1.37-2.40]) and anxiety symptoms (RR=1.66 [1.08-2.71]). Women also had a greater risk of being classified as having depressive (RR=1.36 [1.07-1.63]) and anxiety symptoms (RR-1.95 [1.39-2.84]).

CONCLUSIONS

At the start of their first year of medical school, African American and female medical students were at a higher risk for depressive symptoms and anxiety than their White and male counterparts, respectively. The findings of this study have practical implications as poor mental and overall health inhibit learning and success in medical school, and physician distress negatively affects quality of clinical care.

Professional commitment and attributional style of medical-college nursing students in China: A cross-sectional study

BACKGROUND

The persistent shortage of nurses has become a common phenomenon around the world. Nursing students' professional commitment affects their decision to choose nursing as a professional career. However, there is little knowledge about the professional commitment of nursing students, especially its relationship with attributional style.

OBJECTIVES

To explore the professional commitment of nursing students and to identify the role of attributional style on nursing students' professional commitment.

DESIGN

Cross-sectional study design.

SETTINGS AND PARTICIPANTS

This study was conducted at three different medical colleges in Jinan, Shandong Province, China and included 1230 nursing students. A total of 1223 valid questionnaires were returned, yielding a response rate of 99%.

METHODS

The Professional Commitment Scale and the Multidimensional-Multiattributional Causality Scale (MMCS) were used to investigate nursing students' professional commitment and attributional style. Basic demographic information about the nursing students was collected. Stepwise regression analysis was used to analyze the data.

RESULTS

The mean scores on the Professional Commitment Scale were 3.54±5.29 (mean±SD). Professional commitment of first year students was higher than that of second year students. Their residence affected their affective commitment, ideal commitment, and continuance commitment which were the sub-dimensions of professional commitment. Effort and ability attribution positively influenced professional commitment; however, context attribution negatively influenced it.

CONCLUSIONS

It is imperative to take effective measures to improve nursing students' professional commitment. Our findings indicated that attributional style had a significant effect on professional commitment; thus, effort and ability attribution need to be emphasized.

Sources of Stress and Coping Strategies among Undergraduate Medical Students Enrolled in a Problem-Based Learning Curriculum

Background. Medical education is rated as one of the most difficult trainings to endure. Throughout their undergraduate years, medical students face numerous stressors. Coping with these stressors requires access to a variety of resources, varying from personal strengths to social support. We aimed to explore the perceived stress, stressors, and coping strategies employed by medical students studying in a problem-based learning curriculum. Methodology. This is a cross-sectional study of randomly selected medical students that explored demographics, perceived stress scale, sources of stress, and coping strategies. Results. Of the 378 medical students that participated in the study, males were 59.3% and females 40.7%. Nearly 53% of the students often felt stressed, and a third felt that they could not cope with stress. Over 82% found studying stressful and 64.3% were not sleeping well. Half of the students reported low self-esteem. Perceived stress scores were statistically significantly high for specific stressors of studying in general, worrying about future, interpersonal conflict, and having low self-esteem. Coping strategies that were statistically significantly applied more often were blaming oneself and being self-critical, seeking advice and help from others, and finding comfort in religion. Female students were more stressed than males but they employ more coping strategies as well. Conclusions. Stress is very common among medical students. Most of the stressors are from coursework and interpersonal relationships. Low self-esteem coupled with self-blame and self-criticism is quite common.

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.

A mindfulness-based stress prevention training for medical students (MediMind): study protocol for a randomized controlled trial

Background

Medical training is very demanding and associated with a high prevalence of psychological distress. Compared to the general population, medical students are at a greater risk of developing a psychological disorder. Various attempts of stress management training in medical school have achieved positive results on minimizing psychological distress; however, there are often limitations. Therefore, the use of a rigorous scientific method is needed. The present study protocol describes a randomized controlled trial to examine the effectiveness of a specifically developed mindfulness-based stress prevention training for medical students that includes selected elements of cognitive behavioral strategies (MediMind).

Methods/Design

This study protocol presents a prospective randomized controlled trial, involving four assessment time points: baseline, post-intervention, one-year follow-up and five-year follow-up. The aims include evaluating the effect on stress, coping, psychological morbidity and personality traits with validated measures. Participants are allocated randomly to one of three conditions: MediMind, Autogenic Training or control group. Eligible participants are medical or dental students in the second or eighth semester of a German university. They form a population of approximately 420 students in each academic term. A final total sample size of 126 (at five-year follow-up) is targeted. The trainings (MediMind and Autogenic Training) comprise five weekly sessions lasting 90 minutes each. MediMind will be offered to participants of the control group once the five-year follow-up is completed. The allotment is randomized with a stratified allocation ratio by course of studies, semester, and gender. After descriptive statistics have been evaluated, inferential statistical analysis will be carried out with a repeated measures ANOVA-design with interactions between time and group. Effect sizes will be calculated using partial η-square values.

Discussion

Potential limitations of this study are voluntary participation and the risk of attrition, especially concerning participants that are allocated to the control group. Strengths are the study design, namely random allocation, follow-up assessment, the use of control groups and inclusion of participants at different stages of medical training with the possibility of differential analysis.

Trial registration

This trial is recorded at German Clinical Trials Register under the number DRKS00005354 (08 November 2013).

Validation of a 15-item care-related regret coping scale for health-care professionals (RCS-HCP)

OBJECTIVES

Coping with difficult care-related situations is a common challenge for health-care professionals. How these professionals deal with the regrets they may experience following one of the many decisions and interventions they must make every day can have an impact on their own health and quality of life, and also on their patient care practices. To identify professionals most at need for extra support, development and validation of a tool measuring coping style are needed.

METHODS

We performed a survey of physicians and nurses of a French-speaking University hospital; 469 health-care professionals responded to the survey, and 175 responded to the same survey one-month later. Regret was assessed with the regret coping scale developed for this study, self-report questions on the frequency of regretted situations and the intensity of regret. Construct validity was assessed using measures of health-care professionals' quality of life (including job and life satisfaction, and self-reported health) as well as sleep problems and depression.

RESULTS

Based on factor analysis and item response analysis, the initial 31-item scale was shortened to 15 items, which measured three types of strategies: problem-focused strategies (i.e., trying to find solutions, talking to colleagues) and two types of emotion-focused strategies, A (i.e., self-blame, rumination) and B (e.g., acceptance, emotional distance). All subscales showed high internal consistency (α >0.85). Overall, as expected, problem-focused and emotion-focused B strategies correlated with higher quality of life, fewer sleep problems and less depression, and emotion-focused A strategies showed the opposite pattern.

CONCLUSIONS

The regret coping scale (RCS-HCP) is a valid and reliable measure of coping abilities of hospital-based health-care professionals.

Oxidative stress and psychological functioning among medical students

BACKGROUND

Oxidative stress has gained attention recently in behavioral medicine and has been reported to be associated with various psychological disturbances and their prognoses.

OBJECTIVES

Study aims to evaluate the oxidative stress (malonylaldehyde (MDA) levels) and its relation with psychological factors (dimensions of personality, levels of anxiety, stress, and depression) among medical/paramedical students of 1(st) and 3(rd) year).

MATERIALS AND METHODS

A total of 150 students; 75 from 1(st) year (2010-2011) and75 from 3(rd) year (2009-2010); of medical and paramedical background were assessed on level of MDA (oxidative stress) and personality variables, that is, level of anxiety, stress, and depression. These psychological variables were correlated with the level of their oxidative stress.

RESULTS

Findings revealed that both groups are influenced by oxidative stress and their psychological variables are also compatible in order to confirm their vulnerabilities to stress.

CONCLUSIONS

Stress in 3(rd) year students was significantly higher and it was noted that it adversely affects the psychological parameters. Hence, special attention on mental health aspect in these students may be given.

Beyond prevalence to process: the role of self and identity in medical student well-being

CONTEXT

Problematic stress levels among medical students have been well established. This stress can lead to depression, suicidal ideation, substance abuse, burnout and cynicism, having a negative effect on students and their patients.

METHODS

We propose to move towards examining the processes underlying well-being in some medical students and vulnerability in others. We draw upon social psychological literature to propose that self-complexity, medical student identity and associated norms all have the capacity to influence medical students' well-being in both positive and negative ways.

RESULTS

We identify two key dilemmas facing medical students with regard to the social psychological factors investigated. First, a diverse set of interests and a high level of self-complexity is thought to buffer against the effects of stress and might also be beneficial for medical practitioners, but the intensive nature of medical education makes it difficult for students to pursue outside interests, leading to a strongly focused identity. Second, a strong group identity is associated with high levels of social support and improved well-being, but unhealthy group norms may have a greater influence on individuals who have a strong group identity, encouraging them to engage in behaviours that place their well-being at risk. A model is proposed outlining how these potentially contradictory social psychological processes may combine to impact upon medical students' well-being.

CONCLUSIONS

There is great scope for investigating the role of self-complexity, identity and norms in the medical education context, with room to investigate each of these factors alone and in combination. We highlight how our proposed model can inform medical educators as to the students who may be most vulnerable to the effects of stress and the potential interventions from which they may benefit. We conclude that social psychological factors make a valuable contribution to understanding the complex issue of well-being in medical education.

Medical students' health-related quality of life: roles of social and behavioural factors

OBJECTIVES

The long and demanding course of medical education may be accompanied by distress with serious consequences. This study was conducted to assess the multidimensional health-related quality of life (HR-QoL) in medical students in different stages of medical education and its associations with behavioural and social factors.

METHODS

A cross-sectional study was conducted in medical students at three medical schools at, respectively, Tehran University of Medical Sciences, Aja University of Medical Sciences and Baghiyatalah Medical School, in November and December 2011 using stratified sampling. Data were obtained on participants' characteristics, including gender, current education stage, living situation, smoking status, physical activity, and membership of associations or teams. Health-related QoL was measured using the Persian version of the 36-item Short Form Health Survey (SF-36), which generates a physical component score (PCS) and a mental component score (MCS). Logistic regression was applied to measure the adjusted associations between variables.

RESULTS

Of the 1350 students invited, 1086 individuals completed the survey to give a response rate of 80.4%. Logistic regression showed male gender (odds ratio [OR] = 2.88, p < 0.001), living with family versus in a dormitory (OR = 2.72, p < 0.001) and participation in daily physical activity (OR = 16.96, p < 0.001) to be significantly associated with a higher PCS. Being in an internship versus in the basic sciences stage of medical education showed a significant association with a lower PCS (OR = 0.12, p < 0.001). Similarly, male gender (OR = 1.67, p < 0.05), living with family rather than in a dormitory (OR = 16.91, p < 0.001), daily physical activity (OR = 25.36, p < 0.001), and membership of associations or teams (OR = 3.67, p < 0.001) were associated with a higher MCS. Likewise, studying in internship rather than in the basic sciences stage was accompanied by a lower MCS (OR = 0.12, p < 0.001).

CONCLUSIONS

This large, multi-institution study, despite its limitations, indicates that medical students in internships show lower scores in all domains of QoL. Social engagement is an important associate of higher HR-QoL. Further studies should address the efficacy of interventions, such as self-awareness programmes and initiatives to encourage students to be more physically and socially active, in improving students' health.

Measurement of specific medical school stress: translation of the "Perceived Medical School Stress Instrument" to the German language

Objective: Medical students encounter specific stressors during their studies. As a result, they develop anxiety, depression and burnout symptoms more frequently than their similarly aged, but employed counterparts. In 1984, Vitaliano et al. published a 13-item instrument for the measurement of stress specific to medical school: the “Perceived Medical School Stress Instrument“ (PMSS). Since then, it has been widely applied and validated in English-speaking countries. No German version of the PMSS exists to date. Thus, our aim was to translate the instrument into the German language in order to be able to measure medical school stress in German-speaking countries.

Method: The items of the PMSS were translated into German by three separate researchers. The resulting translations were compared and combined with each other to establish a first German version of each item in the PMSS. These items were then translated back into English by two native English speakers to validate the correct primary translation. Based on a revised German version, a cognitive debriefing with 19 German medical students and a theoretical testing on 169 German medical students, the final German translations for each of the 13 items were determined.

Results: The PMSS was easily translated into German and there was a high congruency between the primary translations into German and the secondary translations back into English. Incongruities between the translations were solved quickly. The assessment of the German equivalent of the PMSS showed good results regarding its reliability (Cronbach’s Alpha 0.81).

Conclusion: A German version of the PMSS is now available for measuring the medical school related stress in German-speaking countries.

Burnout and career choice motivation in medical students

BACKGROUND

Burnout is a stress-induced syndrome, which affects medical students. Some environmental and personal factors can favor burnout onset and its serious consequences as dropping out, sleep disorders, depression, and suicide. The motivation for choosing medicine is a personal aspect that can modulate the distress with academic demands.

METHODS

We applied self-administered questionnaires in 277 medical students to investigate the predictive role of career choice motivations on burnout dimensions. Specifically, we studied the influence of the main reasons for choosing medicine on emotional exhaustion, cynicism, and academic efficacy.

RESULTS

Intellectual curiosity, professional autonomy, altruism, and interest in human relationships were the most common reasons for choosing medicine. However, the medical students motivated by personal illness or family member's illness or death revealed a significant greater emotional exhaustion when compared with the students with other motivations.

CONCLUSION

The students who apply for medical school motivated by illness/death experiences are at a great risk for burnout. We suggest that students who are at risk for emotional exhaustion can be identified at the admission of medical school. Primary prevention strategies for burnout should consider this risk group.

Work-related behaviour and experience patterns of nurses in different professional stages and settings compared to physicians in Germany

Working in a health-care profession is correlated with high levels of stress and potential burnout that are likely to increase over time. Few studies differentiate psychosocial stress between nurses in different clinical settings or professional stages. In this cross-sectional study, we compared the work-related behaviour and experience of nurses (n=389) and physicians (n=344) and of nurses across different career stages and clinical settings in Germany. Nurses had the lowest proportion of a healthy behaviour and experience pattern (11.6%) compared with student nurses (32.6%), senior nurses (25%), and physicians (16.7%). They also had the highest proportion of a burnout-related behaviour and experience pattern (32.8% vs 26.1% of student nurses, 18.3% of senior nurses, and 27.3% of physicians). In comparison with medical nurses, psychiatric nurses presented a significantly (P<0.01) lower proportion with a healthy (10.6% vs 21.8%) and burnout-related behaviour pattern (23.5% vs 29.6%), and a higher proportion showing a low commitment to work (61.4% vs 34.4%). Differences in health-related dimensions were primarily observed in the domains of professional commitment and stress resistance. The observed differences in behaviour and experience patterns as a function of health-care settings and career stages emphasize the need for specific interventions.

Perceived sources of stress amongst Chilean and Argentinean dental students

INTRODUCTION

The prevalence of high levels of stress as well as its multilevel consequences is well documented amongst students in the health sciences, and particularly in dentistry. However, investigations of perceived stress amongst Spanish-speaking student groups are sparse. This study aimed to (i) describe the translation, adaptation and psychometric properties of a Spanish version of the Dental Environment Stressors questionnaire and (ii) to examine the perceived sources of stress and their associations with the students' study year and gender in two dental schools in Latin America.

MATERIALS AND METHODS

All students officially registered in the dental schools of the University of San Sebastian (USS) in Chile and the Catholic University of Cordoba (CUC) in Argentina were invited to participate in the study. The DES30 questionnaire was adapted in Spanish using translation/back-translation, an expert bilingual committee, and consensus building. Cronbach's alpha was used to measure the instrument's internal consistency, and iterated principal factor analysis with promax rotation was employed to explore its underlying factor structure. Descriptive, bivariate and multivariate methods were used to examine the patterns of association between individual stressors, factor scores and students' characteristics.

RESULTS

Three hundred and four students comprised the study's analytical sample, with two-thirds of those being female. The DES30-Sp demonstrated good internal consistency (Cronbach's α = 0.89). A four-factor solution emerged and included 'academic workload', 'clinical training', 'time constraints' and 'self-efficacy beliefs' factors. 'Fear of failing a course or a year', 'examinations and grades' and 'lack of time for relaxation' were amongst the top individual-item stressors reported by students in both schools. Amongst this group of undergraduate dental students, those in Argentina, in higher study year, and females reported higher perceived stress.

CONCLUSIONS

Increased workload, time constraints and some aspects of clinical training were the top stressors of approximately 300 Chilean and Argentinean dental undergraduates. Some variations between schools, males and females and study years were noted. The Spanish version of the DES30 questionnaire performed well, but future studies should evaluate the instrument's properties in larger and more diverse dental student populations.

Mental health of Polish students and the occurrence of respiratory tract infections

The aim of the paper was to examine the association between the psychological status and the occurrence of respiratory tract infections which constitute the most common group of disorders in the student population. The study comprised 500 Polish students aged 19-21. Two psychological scales were utilized: the Goldberg GHQ-12 scale to examine the general psychological status and the CES-D scale to evaluate the symptoms of depression. In addition a pro-health questionnaire in the examined group of students was performed. We found an increased stress level in 51% of students and the symptoms of depression in 22%. An association between distress and the occurrence of respiratory tract infections was found, based on statistical analyses. The highest stress level and related high distress index were observed in the students suffering from lower respiratory tract infections (7.1 scale value). This group self-evaluated their health status as poor, based on the pro-health questionnaire. In the same group of students, lack of sleep (5.4), lack of regular eating habits (4.2) and lack of physical activity (3.9) were also observed. The study shows that the Polish student population is exposed to increased stress level, which, in turn, increases the occurrence of respiratory tract infections.

The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: the Opening Minds Scale for Health Care Providers (OMS-HC)

BACKGROUND

Research on the attitudes of health care providers towards people with mental illness has repeatedly shown that they may be stigmatizing. Many scales used to measure attitudes towards people with mental illness that exist today are not adequate because they do not have items that relate specifically to the role of the health care provider.

METHODS

We developed and tested a new scale called the Opening Minds Scale for Health Care Providers (OMS-HC). After item-pool generation, stakeholder consultations and content validation, focus groups were held with 64 health care providers/trainees and six people with lived experience of mental illness to develop the scale. The OMS-HC was then tested with 787 health care providers/trainees across Canada to determine its psychometric properties.

RESULTS

The initial testing OMS-HC scale showed good internal consistency, Cronbach's alpha = 0.82 and satisfactory test-retest reliability, intraclass correlation = 0.66 (95% CI 0.54 to 0.75). The OMC-HC was only weakly correlated with social desirability, indicating that the social desirability bias was not likely to be a major determinant of OMS-HC scores. A factor analysis favoured a two-factor structure which accounted for 45% of the variance using 12 of the 20 items tested.

CONCLUSIONS

The OMS-HC provides a good starting point for further validation as well as a tool that could be used in the evaluation of programs aimed at reducing mental illness related stigma by health care providers. The OMS-HC incorporates various dimensions of stigma with a modest number of items that can be used with busy health care providers.

The impact of personality traits on emotional responses to interpersonal stress

Objective

The aim of the present study was to examine the impact of personality traits on emotional responses to interpersonal stress.

Methods

Thirty-two healthy college students (18 men, 14 women; age 25.2±2.7 years) participated in the study. Mood and anxiety were assessed with the Beck Depression Inventory and the State Trait Anxiety Inventory. Personality traits were assessed with the Interpersonal Sensitivity Measure (IPSM). The subjective emotional responses of participants to different (i.e., negative, neutral, and positive) interpersonal feedback were measured.

Results

Subject responses were positive to positive interpersonal feedback and negative to negative interpersonal feedback. The IPSM fragile inner self subscore was negatively correlated with the subjective emotional ratings in response to interpersonal feedback. No correlation was found between validation measures (i.e., the degree of attention in the task and task difficulty) and subjective emotional responses.

Conclusions

Taken together, emotional responses to interpersonal stress may be modulated by personality traits and may impact health and psychological outcomes. Therefore, proper screening and stress management programs that focus on personality traits may improve the mental health of college students.

Well-being and help-seeking: an exploratory study among final-year medical students

OBJECTIVE

Doubts, competitiveness and preparation for the residency examination increase stress and insecurity at the end of medical course. Well-being is very important at this point, but it is known that medical students are reluctant to seek help, particularly for emotional problems. This study investigated the relationship among well-being, perceived needs and help-seeking in final-year students.

METHODS

Well-being was assessed using Beck's Inventories of Anxiety (BAI) and Depression (BDI) and the WHOQOL-brief (quality of life). A questionnaire was used to assess perceived needs and medical school support resources.

RESULTS

The students reported good quality of life (68%) but presented anxiety (27%), depression (20%) and impaired social functioning. Fifty-one percent of the students acknowledged academic needs and 25% psychological needs. Only a portion of the students with anxiety and depression or bad quality of life used the institutional support. Female gender, perceived psychological needs and anxiety symptoms were associated to the use of the Mental Health Service. Satisfaction with mentoring relationships and positive changes were associated to Mentoring attendance.

CONCLUSION

There are different factors involved in help-seeking and identifying specificities in the use of institutional support resources can help to develop strategies to sensitize students about help-seeking during the medical course.

The quality of life of medical students studying in New Zealand: a comparison with nonmedical students and a general population reference group

BACKGROUND

Quality of life is an essential component of learning and has strong links with the practice and study of medicine. There is burgeoning evidence in the research literature to suggest that medical students are experiencing health-related problems such as anxiety, depression, and burnout.

PURPOSE

The aim of the study was to investigate medical students' perceptions concerning their quality of life.

METHODS

Two hundred seventy-four medical students studying in their early clinical years (response rate = 80%) participated in the present study. Medical students were asked to fill in the abbreviated version of the World Health Organization Quality of Life questionnaire to elicit information about their quality of life perceptions in relation to their physical health, psychological health, social relationships, and environment. Subsequently, their responses were compared with two nonmedical students groups studying at a different university in the same city and an Australian general population norm. The findings were compared using independent group's t tests, confidence intervals, and Cohen's d.

RESULTS

The main finding of the study indicated that medical students had similar quality of life perceptions to nonmedical students except in relation to the environment domain. Furthermore, the medical student group scored lower than the general population reference group on the physical health, psychological health, and environment quality of life domains.

CONCLUSIONS

The results suggest that all university students are expressing concerns related to quality of life, and thus their health might be at risk. The findings in this study provided no evidence to support the notion that medical students experience lower levels of quality of life compared to other university students. When compared to the general population, all student groups examined in this study appeared to be experiencing lower levels of quality of life. This has implications for pastoral support, educationalists, student support personnel, and the university system.

Burnout Syndrome and associated factors among medical students: a cross-sectional study

OBJECTIVES

To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors.

METHODS

A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis.

RESULTS

The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68).

CONCLUSION

There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.

Perceived medical school stress and the development of behavior and experience patterns in German medical students

BACKGROUND

Longitudinal data about the development of health risks and resources in relation to the performance of medical students are limited.

AIMS

To evaluate the development of study-related experience and the correlation to performance.

METHOD

Medical students in the first (2006), second (2008), and fifth years (2011) of their studies were surveyed with standard instruments for quality of life, study-related behavior and experience, perceived medical school stress, anxiety and depression, and grades in their first major exam.

RESULTS

The proportion of students with a healthy behavior and experience pattern decreased from 47.3% in the first year to 36.9% in the second year and 17.6% in the fifth year. This corresponded to an increase in the proportion of students at risk for burnout (7.1% first, 20% second, 19% fifth year). Students with a healthy behavior and experience pattern scored higher in self-perceived performance (p < 0.05) and objective grades. Stress and risk for burnout were important predictors for anxiety and depression.

CONCLUSIONS

The decrease in health and the increase in risk patterns indicate a need for prevention and health promotion that should not only focus on individual behavior but also address the contextual factor of study organization within medical school.

Mental health and patterns of work-related coping behaviour in a German sample of student teachers: a cross-sectional study

PURPOSE

The aim of this cross-sectional study was to evaluate the mental health of student teachers, to analyse the extent to which they feel prepared for their profession by the university curriculum and to investigate patterns of coping with occupational stress.

METHODS

A sample of 481 German student teachers was investigated using two standardised instruments: GHQ-12 (General Health Questionnaire) and AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster), an occupational stress and coping questionnaire describing four patterns of work-related coping behaviour. In addition, we asked how well the student teachers felt that the curriculum prepared them for their profession.

RESULTS

Forty-four per cent of the student teachers report impaired mental health in the second teacher training period, indicated by a GHQ value equal to or over the cut-off of four. The AVEM responses revealed more than 40% showing risk patterns (A or B) compared to only 26.3% displaying a healthy coping style (G), while 32.8% demonstrate an unambitious style (S). These GHQ values are inversely correlated with the extent to which student teachers feel prepared for their work by the university curriculum.

CONCLUSIONS

Our data indicate a problematic stress level for student teachers in the second training phase (high exposure to health risks and unfavourable coping styles). Since teaching is clearly an extremely demanding job, it is vital that teacher training systems contribute towards protecting the health of teachers by focusing on fostering healthy personal attitudes and equipping young teachers with coping styles and skills that will better prepare them for the challenges facing them in their daily work. Self-care health management should also be part of the teacher training curriculum.

The impact of eurythmy therapy on stress coping strategies and health-related quality of life in healthy, moderately stressed adults

BACKGROUND

'Stress' and 'health-related quality of life' (HRQoL) are two important theoretical constructs for modern therapy evaluation with clinical relevance. Eurythmy therapy (EYT) is a mind-body-therapy derived from anthroposophic medicine with promising effects on heart rate variability (HRV), HRQoL and disease scores. The purpose of this study was to investigate the impact of EYT on stress coping strategies (SCS) and HRQoL in a controlled study with moderately stressed participants.

METHODS

68 healthy, moderately stressed adults (mean age: 42.2; SD: 8.2) performed 10h of EYT in a group setting over a period of six weeks. A non-randomised control group of 22 healthy adults (mean age: 43.6; SD: 13.7) received no intervention and did only complete the questionnaires at the same data points. Outcomes were measured before and after the intervention (AVEM & SF-36).

RESULTS

A significant impact on SCS was found in seven AVEM scales (MANOVA, F (1/74)=4.59; p=.04). With regard to changes in risk pattern affiliation (AVEM), 24% of the participants receiving EYT (n=55) changed over time from a risky stress coping pattern to a healthier pattern. Concerning the HRQoL four normally distributed scales of the SF-36 ('vitality', 'social functioning', 'mental health' and 'physical functioning') showed a significant group×time interaction favouring the EYT group (MANOVA, F (1/74)=17.26; p<.001). Statistically and clinically relevant mean differences over time of at least eight scale points were found for 'role physical', 'bodily pain', 'vitality' and 'mental health', and of at least 15 scale points for 'role emotional' and 'social functioning'.

CONCLUSIONS

A six-week period of EYT training can result in a significant reduction of stress and consequently improve QoL. Because a significant proportion of participants had high levels of stress at baseline the results suggest a health-enhancing benefit of EYT that may have clinical potential for prevention of stress and associated disorders in healthy individuals and possibly in patients with chronic diseases, for example.

Work-related behaviour and experience pattern in nurses: impact on physical and mental health

Nursing is associated with high levels of emotional strain and heavy workloads. Changing working conditions raise the importance of investigating job satisfaction, stress and burnout and its consequences for nurses. The aim of the study was to investigate whether work-related behaviour and experience patterns are associated with mental and physical health status in nurses. A sample of 356 nurses in four German hospitals were interviewed using questionnaires regarding work-related behaviour and experience patterns, work stress, depression, anxiety and physical symptoms ('Work-related Behaviour and Experience Pattern'--AVEM and ERI). The main result of this study is that unhealthy work-related behaviour and experience patterns (i.e. the excessive ambitious type and the resigned type) are associated with reduced mental and physical health. Preventive, as well as intervention, strategies are needed that focus both on the individual as well as on working conditions.

Study-related health and behavior patterns of medical students: A longitudinal study

BACKGROUND

Little is known about specific health risks and resources and their development influencing medical students' stress.

AIM

To evaluate the development of quality of life and study-related behavior and experience patterns among medical students.

METHODS

Data were collected in the first (n = 112 of 182 in 2006) and the fourth semesters (n = 164 of 176 in 2008). The instruments "Work-Related Behavior and Experience Patterns" (AVEM, including four main patterns: "Health", "Unambitious," "Overexertion," "Burnout") and "Short Form-12 Health Survey (SF-12)" were used at both points in time.

RESULTS

The medical students scored significantly lower on mental health compared with reference samples of young adults. The proportion of students with a healthy pattern decreased from 47.3% (95% CI 38.1-56.5%) in the first semester to 36.9% (29.4-44.4%) in the fourth semester. This corresponded to an increase in the proportion of students at risk for burnout from 7.1% (2.3-11.9%) to 20% (13.8-26.2%). At both time points, female students had a higher risk for overexertion and a lower prevalence of a healthy pattern than male students.

CONCLUSION

Our data provide evidence for a decrease in the healthy pattern and an increase in the burnout pattern. Intervention is needed, especially for students at risk for burnout.

[Psychiatric assessment of physicians on probation]

Psychiatric assessment of physicians on probation is a challenge and has been widely neglected in the forensic literature to date. Based on own experience in this area, some typical cases are described. Physicians with substance use and legal problems are especially common. Some general guidelines for psychiatric assessment are discussed.