Factors associated with motivation in medical education: a path analysis

Medical student´s motivational changes during the COVID-19 university lockdown: a mixed-method study

BACKGROUND

During the crucial stage of the COVID-19 pandemic, face-to-face undergraduate medical education was disrupted and replaced with online teaching activities. Based on its emphasized impact on several outcomes, a deeper insight into the pandemic related effects on medical students´ motivation is aspirational. Therefore, this study aimed to assess the motivational changes that took place during the pandemic in medical students and explored, how motivation of medical students is influenced.

METHODS

Using a mixed method inter-cohort study design, 4th year medical students´ motivation, assessed pre- and post-pandemic were compared. In subsequent qualitative analyses underlying variables that may have contributed to both- medical students´ motivation and pandemic related changes were identified. These variables were then systematically explored- both individually and in combination. In a final step, the results were embedded within the Self-Determination Theory.

RESULTS

Students who were affected by the university lockdown reported significantly higher levels of less self-determined motivation and amotivation. The qualitative analysis identified determinants that influence medical students´ motivation. The common core of these determinants is lacking social interaction and support, with a great emphasis on the interaction with the lecturer and patients.

CONCLUSION

This study emphasizes the crucial role of medical educators, patient contact, social interactions and personal support on students´ motivation. Students need to be strengthened in their beliefs about their abilities, the value of their task at hand and receive encouragement in their efforts. All this will result in an increased identification with the task and less detrimental outcomes.

Medical students' general and radiology-specific motivation: Correlations, stability and associations with learning strategies and ability beliefs

PURPOSE

This study investigated general and subject-specific motivational beliefs from the perspectives of self-determination theory (i.e. intrinsic, identified, introjected, and extrinsic motivation) and achievement goal theory (i.e. mastery, performance-approach, and -avoidance goal orientation including the respective classroom goal structures), their interrelations, their stability over time, and their associations with desirable outcomes (i.e. deep-level learning strategies, self-concept of ability). It was hypothesized that motivational beliefs are interrelated but demonstrate a distinct correlational pattern depending on whether they were assessed as general or subject-specific motivation. In addition, motivational beliefs were hypothesized to relate to learning strategies and ability beliefs.

METHODS

Medical students (n = 146) participated in this longitudinal study with measurement points at the beginning and end of a semester. The questionnaire included established motivational scales to assess motivational beliefs and desirable outcomes. Measurement models were tested using confirmatory factor analyses; correlations of scale means were investigated to assess the nomological network of motivational beliefs.

RESULTS

As expected, intrinsic and identified motivation were associated with mastery goal orientation and with desirable outcome variables, such as the use of deep-level learning strategies. General and subject-specific motivation exhibited distinct correlational patterns. Motivation was relatively stable over time. Results did not confirm the factor structure of classroom goal structure.

CONCLUSIONS

The study emphasizes the benefit of a subject-specific conceptualization of motivation and the need for a careful adaptation of theoretical constructs from the secondary school context to make them fruitful for the promotion of medical students' motivation. Medical teachers can use established motivational interventions (e.g. using an individual frame of reference for feedback) to support students' adaptive motivational beliefs (e.g. self-determined motivation, mastery goals). Given the subject specificity of motivation, it seems beneficial to promote adaptive motivation in the respective medical specialty regardless of students' general motivational characteristics.

Educators' consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design

BACKGROUND

Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education.

MATERIAL AND METHODS

Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes.

FINDINGS

Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools.

CONCLUSION

There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.

Early Ambulation Shortened the Length of Hospital Stay in ICU Patients after Abdominal Surgery

The optimal time to ambulation remains unclear for intensive care unit (ICU) patients following abdominal surgery. While previous studies have explored various mobilization techniques, a direct comparison between ambulation and other early mobilization methods is lacking. Additionally, the impact of time to ambulation on complications and disuse syndrome prevention requires further investigation. This study aimed to identify the optimal time to ambulation for ICU patients after abdominal surgery and considered its potential influence on complications and disuse syndrome. We examined the relationship between time to ambulation and hospital length of stay (LOS). Patients were categorized into the nondelayed (discharge within the protocol time) and delayed (discharge later than expected) groups. Data regarding preoperative functioning, postoperative complications, and time to discharge were retrospectively collected and analyzed. Of the 274 postsurgical patients managed in the ICU at our hospital between 2018 and 2020, 188 were included. Time to ambulation was a significant prognostic factor for both groups, even after adjusting for operative time and complications. The area under the curve was 0.72, and the cutoff value for time to ambulation was 22 h (sensitivity, 68%; specificity, 77%). A correlation between time to ambulation and complications was observed, with both impacting the hospital LOS (model 1: p < 0.01, r = 0.22; model 2: p < 0.01, r = 0.29). Specific cutoff values for time to ambulation will contribute to better surgical protocols.

Identifying academic motivation profiles and their association with mental health in medical school

INTRODUCTION

Academic motivation (AM), motivation in relation to formal studies that as a construct of the self-determination theory (SDT), is frequently assessed by the Academic Motivation Scale (AMS). However, the scoring of AMS in itself is not fully consistent with the SDT theory as only scores of the subscales can be calculated resulting in seven different score means instead of positioning the individual on the self-determination continuum. There have been few attempts at a person-centered approach to AMS scoring, especially among medical students. Our study aimed to find distinct academic motivation profiles and demonstrate their concurrent criterion validity with mental health variables (psychological distress, life satisfaction) among medical students.

METHODS

The AMS-28 college version, the General Health Questionnaire (GHQ-12), and the Single-Item Measure of Life Satisfaction were administered among medical freshmen. Academic motivation profiles were generated by two methods: 1) two-step cluster analysis, and 2) quantile analysis.

RESULTS

The sample consisted of 189 participants (mean age = 19.38 ± 2.03 years, 72% females). The cluster analyses revealed three fairly distinct profiles of self-determination: 'High' (n = 59; mean im = 5.48 ± 0.60; mean em = 6.07 ± 0.41; mean am = 1.57 ± 0.95), 'Moderate' (n = 111; mean im = 4.5 ± 1.06; mean em = 4.41 ± 0.87; mean am = 1.25 ± 0.36), and 'Low' (n = 19; mean im = 4.22 ± 1.02; mean em = 4.03 ± 1.16; mean am = 3.07 ± 1.30). The creation of deciles allowed the identification of those who were most intrinsically (n = 14, 7.4%), extrinsically (n = 10, 5.3%), and least motivated (amotivated) (n = 18, 9.5%). 'Low' self-determination/amotivation was associated with increased psychological distress and decreased life satisfaction.

CONCLUSION

Our results provide means to position medical students on the SDT continuum based on 'Low', 'Moderate', or 'High' levels of self-determination toward their studies. These AM profiles predict the mental health of medical freshmen, which supports the validity of the outcomes and highlight the risks of amotivation for psychological morbidity. The limitations and implications are discussed.

Uncertainty in Medical and Dental Students of Pakistan Regarding Their Future Career and Its Major Causes: A Cross-Sectional Study

OBJECTIVES

This study aimed to evaluate the extent of confidence in medical and dental students regarding their careers after being enrolled in their germane institutes and to identify the magnitude of uncertainty in medical and dental students about their careers and the important causes of this uncertainty.

METHODS

This study was conducted among enrolled students in different medical and dental colleges and universities of Pakistan, including the public and private sectors, from March 1 to March 15, 2023. The level of confidence in their career was evaluated using a close-ended questionnaire of a three-point Likert scale developed and tested by the investigators and approved by the Ethical Review Board (ERB) along with the synopsis. Data were managed and analyzed using Microsoft Excel 19 (Microsoft Corporation, USA) and IBM SPSS Statistics for Windows, version 27 (released 2020; IBM Corp., Armonk, New York, United States).

RESULTS

This study included 1,126 students from public and private medical and dental institutes. The majority of participants 965(85.7%) were satisfied with their chosen profession, and 1,042 (92.5%) students believed they could make a positive contribution to society. Out of the total participants, 246 (21.8%) students showed their intention of changing careers if provided with a comparable/alternative opportunity. A very small proportion, 154 (13.7%), were dissatisfied with their current clinical training and studies. The study also revealed that extra and unjustified academic pressure from institutions is the leading cause of uncertainty among students. Moreover, the lack of psychological support and counseling provided during the academic years adds to the magnitude of uncertainty.

CONCLUSION

In Pakistan, a staggering number of medical and dental students are unsure of their future careers and career prospects. The main causes of this uncertainty are the extra, unwarranted academic pressure that institutions place on students and the dearth of psychological support and counseling offered during the course of studies. This study not only highlights the prevailing uncertainty among medical students but also identifies the causes behind it. Addressing these causes can alleviate the prevailing uncertainty and bring about satisfactory and productive academic achievements without suffering from worries about the future.

Depression and Its Associated Factors among Undergraduate Engineering Students: A Cross-Sectional Survey in Thailand

BACKGROUND

Depression is a common mental health problem that can affect everyone at different stages of development. Though the prevalence rate of depression among university students is rising, exploration among engineering students is limited. The aim of the study was to examine the prevalence of depression and its associated factors of among engineering students in Thailand.

METHODS

A total of 346 students participated in this study. All completed the outcome inventory depression subscale (OI-D) to evaluate the level and prevalence of depression. Other variables assessed included social skills, learning styles, relationship satisfaction, interpersonal difficulty, alcohol use, internet addiction, and neuroticism. Correlation and regression analyses were applied to test the association between sociodemographic and psychosocial factors and depression.

RESULTS

Of the 346 students with the mean age of 20.25 (SD, 1.33), 52.31% were male. Based on the OI-D, 35.3% of participants exhibited symptoms indicative of major depression. Multiple regression showed that only neuroticism, interpersonal difficulties, social skills, and self-esteem appeared to be the significant predictors of depression.

CONCLUSION

The prevalence of depression among engineering students in Thailand was unexpectedly high compared with the prevalence of depression among engineering students in some other countries. Intra- and interpersonal factors were found to be associated with depression. Further study on identifying these risk factors should be encouraged.

Moderating Effect of Variables Associated with Positive Mental Health in a Mediation Model on Depression among College Students: Protocol for a Longitudinal Study

BACKGROUND

Depression is significant mental health issue among university students and can decrease their ability to succeed academically. While various factors associated with mental health problems have been identified, researchers are increasingly exploring the role of positive mental health, such as character strengths and inner strengths, in relation to mental health problems.

OBJECTIVE

This study aims to build upon previous research by examining the influence of positive mental health on the mediation model of depression among students enrolled at Chiang Mai University.

METHOD/DESIGN

This study will employ an observational and longitudinal study that collects data from undergraduate students at Chiang Mai University during the 2023-2024 academic year. The primary outcome of this study will be depression. In the mediation models, insecure attachment and negative family climate will serve as predictors, while borderline personality symptoms will be the mediator. Positive mental health, including character strengths, inner strengths, and resilience, will be tested for moderation effects on the mediation models. Data will be collected at three intervals, with a three-month gap between each collection period.

DISCUSSION AND CONCLUSION

This study will provide insights into the positive and negative mental health outcomes of university students in Chiang Mai. Through comprehensive analysis, this study intends to offer valuable insights into both positive and negative mental health outcomes among university students in Chiang Mai. Moreover, by employing a longitudinal approach, it aims to establish a more robust understanding of the causal relationships between positive mental health, predictors, mediators, and depression. The study's limitations will also be discussed.

Developing low-achieving medical students' self-regulated learning using a combined learning diary and explicit training intervention

INTRODUCTION

The development of self-regulated learning (SRL) is an essential educational component of remediation for low-achieving students. The aim of this study was to design, implement, and evaluate a longitudinal SRL intervention combining both a structured learning diary and explicit SRL training in a cohort of low-achieving undergraduate medical students.

MATERIALS AND METHODS

A mixed methods quasi-experimental study was conducted, with a pretest-posttest study in the intervention group and comparison of the GPA and course grade of the intervention group with a historical comparison group. A questionnaire and focus group explored the participants' perceptions about the intervention.

RESULTS

The SRL scores (total and rehearsal, organization, critical thinking, metacognitive regulation, time management and environment management) and course grade of participants were significantly improved in the intervention group. The course grade of participants was significantly higher than the comparison group but the GPA was not significantly different. Overall, the participants were positive about the intervention.

CONCLUSIONS

This study was the first in medical education to evaluate the effectiveness and user acceptability of an SRL intervention that combined a structured learning diary and explicit SRL training in low-achieving medical students. Further research is recommended in different contexts and with larger number of students.

Learning styles of medical students and related factors

BACKGROUND

The concept of learning style is quite important for teachers to teach, organize students' learning experiences, and accomplish educational goals. Motivation is one of the most important psychological concepts in education. Motivation is multidimensional and ranges from amotivation to extrinsic motivation and intrinsic motivation. When students are motivated extrinsically, they enjoy striving toward rewards and goals which may differ from individual goals. Intrinsically motivated students enjoy exploring, learning, and curiosity-oriented academic efforts. Understanding learning styles can make it easier to create, modify, and develop more efficient curriculum and educational programs. It can also encourage students' participation in these programs and motivate them to gain professional knowledge This study aims to determine the learning styles of medical school students and to evaluate whether there is a relationship between their learning styles and academic motivation and the sociodemographic variables.

METHODS

In this study a questionnaire containing socio-demographic factors, Grasha-Reichmann Learning Styles Scale, Academic Motivation Scale was filled out by 1st, 2nd, 3rd, 4th, and 5th -year medical students of the 2019-2020 academic year. Frequency, percentage, mean, ANOVA, Pearson correlation analysis, and independent group t-test (for analyzing data with normal distribution) were applied. Mann Whitney U test, Kruskal Wallis test, and Spearman correlation analysis were used for analyzing data without normal distribution.

RESULTS

We found that the mean of independent learning was the highest among the learning style dimensions, and the mean of the intrinsic motivation to know (IMKN) was the highest among the academic motivation dimensions. We found that there were significant relationships between independent learning and intrinsic motivation (IM), between avoidant learning and extrinsic motivation (EM) and between collaborative learning and IMKN, IM to accomplish things (IMAT) and IM to experience stimulation (IMES).

CONCLUSION

We think that different teaching methods can be applied to strengthen collaborative learning, participant learning, and intrinsic motivation. We hope that this research will contribute to medical education on the subject of establishing appropriate teaching methods. Teachers have to plan and implement activities based on students' learning styles and academic motivation to encourage students to effectively participate in the classroom.

Buffering Effect of Perseverance and Meditation on Depression among Medical Students Experiencing Negative Family Climate

Background and objective: Thirty percent of Thai medical students experienced depression. Two of the crucial factors related to depression involved borderline personality disorder symptoms and adverse family experiences, while positive strengths were documented to prevent depression. This study aimed to investigate the role of perseverance and meditation on depression; Methods: Two hundred and forty−three medical student participants completed the following measurements: the core symptom index (CSI−D) to measure depression, the family climate questionnaire to measure family experience, the personality disorder questionnaire to measure borderline personality disorder symptoms, and the inner strength−based inventory to measure perseverance and meditation. In the analysis, depression served as an outcome, adverse family climate as a predictor and borderline personality disorder symptoms as a mediator. In contrast, perseverance and meditation were moderators in the mediation model. Mediation and moderation analysis using PROCESS was applied for testing the direct and indirect effects; Results: Among all, 49.38% were male, and the mean age was 22.76 years. Borderline personality disorder symptoms significantly mediated the relationship between adverse family climate and depression, B = 0.0608 (95%CI, 0.0301 to 0.1052). The variance explained by the mediation model was 43%. Meditation moderated the relationship between adverse family climate and borderline personality symptoms, whereas perseverance and meditation were found to be significant moderators for borderline personality disorder symptoms and depression. With two moderators in the mediation model, the indirect effect index was B = 0.0072 (95%CI, 0.0002 to 0.0160). The 49% of variances of depression were explained by the moderated mediation model; Conclusion: Borderline personality disorder symptoms are a crucial variable involving depression. Meditation practice has been demonstrated to be a buffer between negative family climate to borderline personality disorder symptoms and depressive symptoms, whereas perseverance buffers the effect of borderline personality disorder symptoms of depression. Further research on cultivating meditation and perseverance should be encouraged among those with negative family experiences.

Exploring the situational motivation of medical students through clinical medicine level test: a cross-sectional study

China's Clinical Medicine Level Test (CMLT) was designed to evaluate the key factors that affect the learning outcome of medical students prior to entering clinical practice. In this study, we systemically analyzed the performance of a cohort of medical students at Jinan University School of Medicine participating in the recent CMLT. The analytical results of the medical students' written and objective structured clinical examination (OSCE) scores showed that their academic performance was predominantly associated with students' internship allocations, although other demographic characteristics such as sex, age, geographical origin of students, and grade point average (GPA) might be sporadically related to the students' OSCE performance at different OSCE stations. To explore the inherent reasons behind this, a survey was implemented among the medical students who participated in the examination to further interpret the factors influencing the students' learning outcome. The findings of this questionnaire manifested that intrinsic motivation and identified regulation acted as the major motivational profiles for the medical students from three different internship sites, whereas external regulation emerged as the crucial factor to make the students perform well academically in the CMLT. The result of this study suggested that strengthening the quality control of the clinical learning environment and improving medical administration may still be the most effective approaches to ensure the quality of clinical medical education.

An initial preparation for human cadaveric dissection ameliorates the associated mental distress in students

It is universally recognized that cadaveric dissection is an essential part of anatomy training. However, it has been reported to induce mental distress in some students and impair their intrinsic motivation (IM) to study. One of the postulated reasons for this behavior is the lack of adequate information and preparation of students for cadaveric dissection. Therefore, it is hypothesized that providing relevant information prior to cadaveric dissection will ameliorate the mental distress, enhance the IM of students, and improve their academic performance. A cohort of occupational therapy students enrolled in an anatomy course were psychologically prepared for cadaveric dissection. Students were provided with a curated list of YouTube videos and peer-reviewed journal articles related to cadaveric dissection prior to the commencement of the anatomy course. All students were also required to attend an oral presentation immediately before commencing dissection. The control group included students who had not been provided with any resources in preparation for cadaveric dissection. Compared to the control group, students who had been prepared demonstrated better quality of cadaveric dissection, improved academic performance, reported less mental distress and greater IM. Moreover, students reported the oral presentation to be most relevant and journal articles to be least useful in their preparation. Therefore, this is an effective approach in the amelioration of mental distress and improvement of performance in anatomy students. Consequently, this study represents a paradigm shift in the pedagogy of anatomy, and could represent a vital element in the evolution of a revitalized anatomy curriculum.

Because We Care: A Philosophical Investigation into the Spirit of Medical Education

Although in health care education we encounter the word care at every turn, the concept is hardly ever defined or subjected to scrutiny. Care is a foundational concept of health care education, and if we do not take control of our basic concepts, their meaning can be subject to other influences. We take a philosophical approach to care and ask what care is, to connect different conceptions of care in health care education to their common root. We do this by first examining how the concept is used in health care education, how it features in Martin Heidegger's Being and Time, and finally, how these philosophical implications may be applied to medical education. The use of care in medical education suggests that it is foundational to understanding health care education. However, presently the concept is ambiguous and risks being a 'container concept' that becomes meaningless because it is used generally. In publications that feature the concept, it is usually in service of another aspect that is under investigation, and not care itself. For instance, publications on teaching patient-centred care focus on the meaning of 'patient-centeredness' rather than care. In 'health care', there are debates about what 'health' means, but not care. The concept is also used in different and sometimes contradictory meanings: care as the organizational structure of health care that safeguards (health care system), care as empathy or careful attention of medical trainees for patients (caring about one's patients, treating them carefully), and, finally, care as motivation and focus toward a goal (caring about graduating, making a contribution). We turn to the philosophy of Heidegger to integrate these different appearances of care into a unified structure. Heidegger's Being and Time describes care as the basic ontological structure of human existence. This turns out to be a structure of time: in the familiar structure of past present and future. Anticipating a future end, which determines our attitude toward the people, objects, and physical structures we are with now, and in the light of which we orient ourselves to what is already there. By describing the ontological (foundational) structure of care, we argue that care is the spirit of health care education. This unifying structure can be used to integrate phenomena that are recognized as important in health care education but are usually seen as separate. We use an example to illustrate how empathy, health protocols, and educational goals can be connected in one situation. Just as health provides a framework for patient management, care can provide this framework for education. This fundamental concept of care can be used in practice for reflection on anticipated ends in situations in which different modes of care seemingly conflict. Beyond our focus on care, we also illustrate how one can take an important concept in health care education and use philosophy to root it in a foundational understanding of that concept.

COVID-19 outbreak improves attractiveness of medical careers in Chinese senior high school students

BACKGROUND

The shortage of healthcare workers is becoming a serious global problem. The underlying reasons may be specific to the healthcare system in each country. Over the past decade, medicine has become an increasingly unpopular profession in China due to the heavy workload, long-term training, and inherent risks. The ongoing COVID-19 pandemic has placed the life-saving roles of healthcare professionals under the spotlight. This public health crisis may have a profound impact on career choices in Chinese population.

METHODS

We conducted a questionnaire-based online survey among 21,085 senior high school students and 21,009 parents from 24 provinces (or municipalities) of China. We investigated the change of interest in medical study due to the outbreak of COVID-19 and the potential motivational factors based on the expectancy-value theory framework. Pearson correlation analysis was used to assess the correlation of static or dynamic interest in medical career pursuit with the reported number of COVID-19 cases. Logistic regression model was adopted to analyze the main factors associated with students' choices.

RESULTS

We observed an increased preference for medical study post the outbreak of COVID-19 in both students (17.5 to 29.6%) and parents (37.1 to 47.3%). Attainment value was found to be the main reason for the choice among students, with the contribution to society rated as the top motivation. On the other hand, the predominant demotivation in high school students was lack of interest, followed by concerns regarding violence against doctors, heavy workload, long-term training and heavy responsibility as a doctor. Additionally, students who were female, in the resit of final year, had highly educated parents and outside of Hubei province were significantly associated with a keen interest in pursuing medical study.

CONCLUSIONS

This is the first multi-center cross-sectional study exploring the positive change and motivations of students' preferences in medical study due to the outbreak of COVID-19. Our results may help medical educators, researchers and policymakers to restructure medical education to make it more appealing to high school students, particularly, to develop a more supportive social and working environment for medical professionals to maintain the observed enhanced enthusiasm.

The Effect of Digital Game-Based Learning on Learning Motivation and Performance Under Social Cognitive Theory and Entrepreneurial Thinking

This study aims to investigate the effects of students’ learning motivation and learning performance in a digital game-based learning setting and the structure of competition. This study uses Social Cognitive Theory, which emphasizes the bidirectional effects between personal factors, environmental factors, and behavior. We use the emotional state as the personal factor, social support as the environmental factor, learning performance as behavior. We also use self-efficacy and learning motivation as the mediating factors in the model. Data samples were collected from approximately 600 students in junior high schools in Taiwan. The students learned via either application or conventional lectures in three groups. The Control Group (CG) learned the course through a conventional learning approach. The Experimental group 1 (EG1) learned by a digital game, while Experimental Group 2 (EG2) learned through the digital game in combination with a structure that involved competing and entrepreneurship with classmates. The result of this research shows that the emotional state negatively affects learning motivation and self-efficacy, that self-efficacy will positively affect learning motivation, social support will positively affect self-efficacy, and self-efficacy and learning motivation will both positively affect learning performance. In addition, this research certifies previous works that entrepreneurs prefer to be more aggressive in competitions, have a high demand for accomplishment motivation, and are more likely to facilitate competitive over non-competitive environments.

Prevalence and Predictors for Depression among Medical Students during Coronavirus Disease-19 Pandemic: A Cross-sectional Study

BACKGROUND: Since the declaration of the World Health Organization of the coronavirus (SARS-COV-2) as a pandemic, several countries have locked down and quarantined their residents with restrictive procedures to control spread of the disease. Due to pandemic related stressors, concerns and worries have developed regarding negative psychological impact on the mental well-being of the general population, particularly those known to have higher levels of psychological impairment with high vulnerability to mental health diseases such as medical students. AIM: The objectives of the study were to assess the prevalence of self-reported depression and to explore its predictors during the period of Coronavirus Disease 2019 first lock down among medical students. METHODS: This was a cross-sectional study design. The study was conducted at Kasr Alainy Medical School, Faculty of Medicine, Cairo University, Egypt, in June 2020. A simple random sample was picked of one subgroup of 4th year medical students (No. = 300) at faculty of medicine during the academic year 2019–2020. Self-administered questionnaires including Beck’s Depression Inventory scoring were distributed using Google form through communication social media such as WhatsApp. RESULTS: Out of the 300 participants, 238 responses were received with response rate 79.3%. Results indicated that 38.2% of the respondents were experiencing depression with different degrees with Beck’s Depression Inventory mean scores was 19.4 ± 11.6. Multiple logistic regression analysis point out that gender (odds ratio [OR] = 2.4 and p = 0.022) and “Good” grade level of academic performance (OR = 7.2 and p = 0.045) are significant predictors for developing depression among the participating medical students. CONCLUSION: A significantly high prevalence of depression is detected among medical students during the first wave of the SARS-COV-2 pandemic. The prevalence of depression is more among females than males and more with medical students achieving “Good” grade level.

Validation of academic motivation scale among medical students using factor analysis and structural equation modeling: Middle Eastern perspective

BACKGROUND

Demanding careers like medicine requires a lot of motivation and the Academic Motivation Scale (AMS) developed by Vallerand et al. (1992) is an instrument to measure motivation. This study evaluated the validity and reliability of AMS among medical students in the Middle East.

MATERIALS AND METHODS

This was a methodological research utilizing a convenient sampling technique. AMS scale comprising 28 items subdivided into seven subscales was administered to 900 students (281 students returned the filled AMS). Data were analyzed using the descriptive statistics, one-way ANOVA, and t-tests. Exploratory factor analysis and Cronbach's alpha were used to evaluate the validity and reliability of the scale, respectively.

RESULTS

There was a statistically significant difference between both genders in overall scores (P = 0.015*), two subscales, namely "Identified Regulation" (P =0.017*) and "Stimulating Experience" (P = 0.015*), with females showing higher value. Second-year students (n = 91) had significantly higher score (10.9 ± 4.1) for "Amotivation" (P =.001*) and first-year students (n = 48) had significantly higher score (16.2 ± 3.0) for "Achievement" subscale (P =.014*). P < 0.05 was considered statistically significant with 95% confidence interval. No statistically significant difference was observed between the groups based on nationality or age. Bartlett's test of sphericity was significant (Chi-square: 2988.010; df = 278; P < 0.001). Kaiser-Meyer-Olkin was 0.890. Principal component analysis with varimax rotation extracted seven factors corresponding to the original items of AMS questionnaire. All subscales correlated positively except "amotivation." Structural equation modeling revealed the relation between observed and unobserved variables.

DISCUSSION

This study demonstrated that AMS is valid and reliable for application among Middle East medical students, without needing any modification. AMS has widespread application in medical education as it impacts learning outcomes.

CONCLUSION

This study demonstrated that AMS is valid and reliable for application among the Middle East students without needing any modification.

Borderline Personality Symptoms: What Not to Be Overlooked When Approaching Suicidal Ideation among University Students

Suicidal ideation is a serious condition antecedent to suicidal attempts and is highly related not only to depression but also other psychosocial factors. This study aimed to examine the predictive effects of these potential factors for suicidal ideation among young adult university students. A cross-sectional survey was conducted on a sample of university students in Thailand. An online questionnaire employed the perceived stress scale-10 (PSS-10), the patient health questionnaire-8 (PHQ-8), the multidimensional scale of perceived social support (MSPSS), and a screening instrument for borderline personality disorder. An ordinal regression analysis was applied to determine the predictive effects of the independent variables. Of 336 students, the mean age was 20.26 ± 1.3 years, 80.4% of whom were female; 14.3% had suicidal ideation. The significant predictors of suicidal thoughts were perceived stress (AOR 1.11, 95% CI 1.01 to 1.22); depressive symptoms (AOR 1.16, 95% CI 1.05 to 1.22); borderline personality symptoms (AOR 1.19, 95% CI 1.01 to 1.40); and perceived social support (AOR 0.97, 95% CI 0.94 to 1.00). Not only did depressive symptoms contribute to suicidal ideation but they also constituted important variables. Therefore, they should be included in intervention plans to prevent suicidality among university students.

Professional identity of medical students: Proposing a Meta Static Structural Model

INTRODUCTION

The realization of professionalism and its desirable consequences, as the most important goal of medical education, primarily depends on identifying the process and mechanism of the professional identity formation, which in turn requires the accurate identification of components and structure of the concept of professional identity. Therefore, the aim of this study was to synthesize a static structural model for professional identity, based on the results of our previous research.

METHODS

In this study the theory or model construction methodology was used to synthesize a static structural model of professional identity formation for medical students. In this regard, the Walker and Avant method was followed through three steps: specifying focal concepts, reviewing the literature, and organizing concepts into an integrated and efficient representation.

RESULTS

In this study, based on the analysis of 9 selected conceptual models in the field of socialization and professional identity, first the key concepts of each model were extracted and then by carefully examining these concepts and determining their relationships and reviewing related texts, dimensions and components of professional identity were determined and presented in the form of a comprehensive structural static model.

CONCLUSION

The advantage of the proposed model over the existing models is the explicit presentation of the dimensions, constructs, and sub-constructs of the concept of professional identity. In addition, this model can be used as a general pattern in all non-medical professions.

The strength of motivation for medical school: A three-year longitudinal study

Based on longitudinal data collected in a sample of Chinese medical students, this study tested the measurement invariance of the strength of motivation for medical school framework and examined the growth trajectories of their motivation for medical school over time. Results revealed that the strength of motivation for medical school scale demonstrated longitudinal measurement invariance. Medical students in our sample showed an overall decline over time in all three types of motivation for medical school. Most of the drop occurred during the first year of medical study. Individual variability was observed in the initial levels and the growth rates of motivation for medical school. We advised medical educators to provide sustained support to help medical students (especially for those early in medical school) improve their learning experience.

Self-Compassion in Irish Social Work Students: Relationships between Resilience, Engagement and Motivation

Self-compassion recognises a meaning of life’s suffering, aligning with existential positive psychology. Although this construct is known to protect our mental health, how to augment self-compassion remains to be evaluated. Social work students suffer from high rates of mental health problems; however, research into self-compassion in this population remains to be developed. This study aimed to evaluate (i) relationships between self-compassion and more traditional positive constructs—resilience, engagement and motivation, and (ii) differences of these constructs between the levels of studies to inform how self-compassion can be enhanced in social work students. A total of 129 Irish social work students completed self-report scales regarding self-compassion, resilience, engagement and motivation. Correlation, regression and one-way MANOVA were conducted. Self-compassion was associated with gender, age, resilience, engagement and intrinsic motivation. Resilience and intrinsic motivation were significant predictors of self-compassion. There was no significant difference in the levels of these constructs between the levels of studies. Findings suggest that social work educators across different levels can strengthen students’ resilience and intrinsic motivation to cultivate the students’ self-compassion. Moreover, the close relationships between self-compassion, resilience and intrinsic motivation indicate that orienting students to the meaning of the studies helps their mental health.

Whole consultation simulation in undergraduate surgical education: a breast clinic case study

BACKGROUND

Safe and effective clinical outcomes (SECO) clinics enable medical students to integrate clinical knowledge and skills within simulated environments. This realistic format may better prepare students for clinical practice. We aimed to evaluate how simulated surgical clinics based on the SECO framework aligned with students' educational priorities in comparison with didactic tutorials.

METHODS

We delivered two breast surgery SECO-based simulated clinics to Year 3 students during their surgical attachments at a London teaching hospital. All students attended a didactic breast surgery tutorial the previous week. Pre- and post-session surveys and post-session debriefs were used to explore learning gain, processes, preferences and impacts on motivation to learn. Data were analysed using inductive thematic analysis to categorise student views into themes.

RESULTS

Seventeen students enrolled in the simulated clinics and debriefs. Students expressed that passing examinations was a key extrinsic motivating factor, although the SECO-based format appeared to shift their motivation for learning towards aspiring to be clinically competent. Self-reported confidence in clinical skills such as history taking and examination improved significantly. Active learning methods were valued. Students expressed a preference for simulated clinics to complement, but not replace, tutorial-based learning.

CONCLUSION

The SECO-based simulated clinic promoted a shift towards intrinsic motivation for learning by allowing students to recognise the importance of preparing for clinical practice in addition to passing examinations. Integration of surgical simulated clinics into the undergraduate curriculum could facilitate acquisition of clinical skills through active learning, a method highly valued by students.

Impact of Perceived Social Support on the Relationship between ADHD and Depressive Symptoms among First Year Medical Students: A Structural Equation Model Approach

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is associated with depression among college students, while perceived social support is also associated with depression, especially among young adults. This study aimed to examine to what extent perceived social support mediated the relationship between ADHD symptoms and depressive symptoms.

METHODS

In total, 124 first year medical students completed the Adult ADHD Self-Report Scale Screener (ASRS), the Patient Health questionnaire-9 and the revised Thai Multidimensional scale of perceived social support reflecting ADHD symptoms, depressive symptoms, and perceive social support, i.e., family members, friends and other significant people, respectively. Structural equation modeling was used to investigate the hypothesized mediation model.

RESULTS

ADHD symptoms exhibited a significant indirect effect on depressive symptoms via perceived social support. ADHD symptoms initially had a direct effect on depression; thereafter, it reduced to a non-significance effect after perceived social support was added. The total variance explained by this model was 35.2%. The mediation model with family support as a mediator showed the highest effect size.

CONCLUSIONS

The study highlighted the importance of perceived social support, particularly family support, on depressive symptoms among young medical students experiencing ADHD symptoms. The model suggests promising relationships for further research on ADHD-related depression and potential treatment in the future.

Psychometric evaluation of Persian version of the balanced measure of psychological needs scale among university students

Aim

The purpose of the present study was to evaluate the reliability, validity and factor structure of the Persian version of the BMPN in Iranian university students.

Design

Cross‐sectional.

Methods

Study was conducted among Iranian medical sciences students from April to May 2020. A total of 660 students participated in the online self‐administrated questionnaire. Construct validity, convergent and divergent validity, and reliability of P‐BMPN were evaluated.

Results

The Exploratory factor analysis showed that the Persian version of the BMPN has 17 items with four factors: dissatisfaction, autonomy Satisfaction, relatedness satisfaction and competence satisfaction that explained 40.17% of the total variance. Based on confirmatory factor analysis, all goodness‐of‐fit indices confirmed the model fit.

Conclusion

These results suggest that the Persian version of the BMPN is a reliable and valid measure to assess satisfaction and dissatisfaction of the psychological needs in Iranian university students.

Mental Strength and Challenges among Thai Medical Students in Their Clinical Years-Study Protocol

(1) Background: Mental well-being and mental health problems are both important, especially among medical students who will be future doctors. The proposed study aimed to explore both positive and negative mental health experiences, especially mistreatment, occurring among medical students in their clinical years. (2) Methods/design: The study will conduct a cross-sectional survey between January 2021 and December 2021, among medical students studying in their clinical years across 23 medical schools throughout Thailand. Measurements regarding character strengths related to medical professionalism as well as other positive mental health strengths and negative mental health problems, e.g., anxiety, depression and experience of mistreatment will be completed. Both medical students and faculty members will be invited to participate in the study. (3) Discussion: this survey will provide an overall picture of medical students' mental well-being, positive and negative aspects of mental health and the magnitude of mistreatment and perspectives they experience. The limitations of the survey will be discussed.

Multiple-to-multiple path analysis model

One-to-multiple path analysis model describes the regulation mechanism of multiple independent variables to one dependent variable by dividing the correlation coefficient and the determination coefficient. How to analyse more complex regulation mechanisms of multiple independent variables to multiple dependent variables? Similarly, according to multiple-to-multiple linear regression analysis, multiple-to-multiple path analysis model was proposed in this paper and it demonstrated more complex regulation mechanisms among multiple independent variables and multiple dependent variables by dividing the generalized determination coefficient. Differently, three other types of paths were generated in multiple-to-multiple path analysis model in that the correlation among multiple dependent variables was considered. Then, the decision coefficient of each independent variable was constructed for dependent variables system, and its hypothesis testing statistics were given. Finally, the research example of the wheat breeding rules in arid area demonstrated that the multiple-to-multiple path analysis considering more correlation information can get better results.

Changes in the learning styles and approaches of students following incorporation of drawing during cadaveric dissection

The teaching of anatomy is challenging due to the constraints of material and personnel resources. Research has established that the learning preferences of students are malleable and determined by the requirements of the course. Further, drawing has been reported to aid learning in anatomy by facilitating problem solving and reducing the cognitive overload in students. Considering these issues, the aims of the study were to investigate (a) if positive changes occur in the learning styles and approaches following the incorporation of drawing during cadaveric dissection, and (b) whether they are associated with improved learning outcomes. One cohort of students in an anatomy course received training in creating scientific drawings from dissected human cadavers, while two cohorts of students did not receive such training. The learning preferences of students and their final examination grades were assessed at the commencement and conclusion of the course. Majority of student who had training in drawing transitioned from being bimodal, to trimodal or quadrimodal learners. This was associated with efficient learning approaches and a significant (p < .05) improvement in learning outcomes in these students. There were no changes in any parameters in students who had not received training in drawing. Therefore, the modulation of learning preferences of students through drawing is a pragmatic approach in anatomy teaching.

Patients Encounter as a Motivating Factor for Academic Performance in a Medical Neuroscience Course

BACKGROUND

The integration of patient encounters into the first year of the medical school curriculum is known to be of vital importance in the development of critical thinking and communication skills. We investigated whether exposure of first year medical students to patient encounters during a first year medical school neuroscience course result in a high level of motivation associated with the clinical encounter, and whether this high level of motivation translates to higher academic performance as measured by their performance on formative and summative examinations.

METHODS

First year medical students interacted with patients presenting with different neurological disorders in a small group informal session. Following the small group interactions with patients, students participated in a large group debriefing session involving discussions with peers, biomedical sciences faculty, and clinicians. Students then completed a survey designed to assess their motivation in correspondence with the Attention, Relevance, Confidence, and Satisfaction (ARCS) model of motivation. These results were then correlated with students' performance in the neuroscience examinations.

RESULTS

The total mean score was high for all categories of the ARCS model of motivation (4.26/5) and was highest for Relevance (4.46/5). When these motivation scores were correlated with students' performance on the formative and summative examinations, a significant positive correlation was found between motivation and performance on both the formative (r = 0.85) and summative (r = 0.95) neuroscience examinations.

CONCLUSION

Encounters with patients presenting with neurological disorders during a first year medical neuroscience course result in a high level of motivation associated with the clinical encounter, and this was positively correlated with their academic performance.

Lebanese students' motivation in medical school: does it change throughout the years? A cross-sectional study

BACKGROUND

Students entering medical school are driven by different types of motivation: autonomous motivation, controlled motivation, or amotivation. Motivation types can influence students' performance, outcome and well-being. To our knowledge, this topic has never been studied in Lebanese medical students. This study aims to identify students' motivation types in the first 5 years of medical school at two Lebanese universities (USJ and USEK). It also aims to determine the predominant motivation type of the whole sample. Results may be the first step towards raising awareness about this topic and implementing actions that enhance autonomous motivation.

METHODS

A cross-sectional study was performed between January and June 2017. A questionnaire was sent to medical students by e-mail. The students' academic motivation was assessed using the Academic Motivation Scale.

RESULTS

A higher mean autonomous motivation score was found in each academic year, as compared to the mean controlled motivation and amotivation scores. The highest mean autonomous motivation score was seen among second year students, whereas the lowest score was noted in fifth year students. The highest scores for controlled motivation and amotivation belonged to the fourth-year students, and the lowest to the first-year students. Students who were still satisfied with medical studies had a higher autonomous motivation score. Finally, USJ students who were satisfied with their second year training had a higher mean autonomous motivation score than those who were not.

CONCLUSION

This study showed high levels of autonomous motivation in the first five years of medical school. Autonomous motivation was the predominant type in the whole sample. The highest scores of controlled motivation and amotivation were noted in the fourth year. Moreover, high levels of self-determination were seen in students who enjoyed their early contacts with patients through trainings. Actions should be implemented in medical schools to enhance and maintain autonomous motivation, and consequently students' outcome and health-care quality.

A partnership-oriented and culturally-sensitive communication style of doctors can impact the health outcomes of patients with chronic illnesses in Indonesia

OBJECTIVES

A partnership-oriented communication style is globally recommended for medical practice. A culturally-sensitive doctor-patient communication guideline is also needed for Southeast Asia. The 'Greet-Invite-Discuss' guideline was established and tested with primary care doctors and their patients in Indonesia.

METHODS

In this mixed-methods study, doctors were trained according to the 'Greet-Invite-Discuss' guideline, while patients received standard treatment. Two groups of fifteen doctors were assigned to have consultations with 45 patients with hypertension or 51 patients with type-2 diabetes mellitus. Doctors' self-assessment and patients' perceptions and their clinical outcomes were longitudinally measured. Six focus group discussions were conducted to explore doctors' and patients' experiences.

RESULTS

Doctors' self-assessments and patients' perceptions of doctors' communication skills increased significantly (p < 0.05). Moreover, patients' blood pressure or fasting blood glucose levels decreased significantly (p < 0.05), except the two-hour blood glucose levels (NS). Qualitatively, doctors demonstrated more partnership and culturally-sensitive communication, and patients expressed more satisfaction, increased comprehension and self-management, of their chronic illnesses.

CONCLUSIONS

The 'Greet-Invite-Discuss' guideline was useful for primary care doctors for a more partnership-oriented and culturally-sensitive communication with patients in chronic care management.

PRACTICE IMPLICATIONS

Using a partnership-oriented and culturally-sensitive communication guideline, doctors can improve their communication skills with their patients towards optimum health outcomes.

Motivation to Learn Neuroanatomy by Cadaveric Dissection is Correlated with Academic Performance

Implementing educational activities, such as a wet lab with cadaveric brain dissection, is known to have a direct impact on medical students' motivation. These activities demonstrate the clinical relevance of concepts taught in the classroom setting. The correlation between motivation and academic performance is not clear. First year medical students participated in wet lab activities. The wet lab included cadaveric dissection of the surface and internal anatomy of the brain, as well as discussions facilitated by the neuroscience faculty and clinicians. Discussions were centered around the clinical relevance of the neuroanatomical features dissected during the wet laboratory activities. Following completion of the laboratory activities, students completed a survey, which was used to assess the students' motivation for learning neuroanatomy based on the Attention, Relevance, Confidence, Satisfaction (ARCS) model of motivation. These results were then correlated with performance on a laboratory examination that tested three-dimensional and cross-sectional knowledge of neuroanatomy and practical skills including the use of imaging techniques. The total mean score of motivation was generally high for all categories of ARCS model of motivation (4.26/5) and was highest for Relevance (4.46/5). When these results were correlated with students' performance on the lab examination, a positive correlation between students' motivation and lab examination scores was found (R² = 0.877). Implementation of the neuroanatomy cadaveric dissection lab led to increased student motivation, which was positively correlated with students' academic performance. Clin. Anat. 32:128-135, 2019. © 2019 Wiley Periodicals, Inc.

The prevalence of depression and associated risk factors among medical students: An untold story in Vietnam

BACKGROUND

Depression is a common mental health problem in medical students worldwide. The association between depression and motivation in Vietnamese medical students is not well-documented.

OBJECTIVES

To estimate the prevalence of self-reported depression and to identify associated risk factors among medical students at Hanoi Medical University (HMU).

METHOD

A cross-sectional study was conducted on medical students with clinical experience at HMU from November 2015 to January 2016. We used the multistage cluster random sampling technique to select and invite students to complete a questionnaire including demographic characteristics, Patient Health Questionnaire 9 (PHQ-9), Academic Motivation Scale (AMS), and International Physical Activity Questionnaire Short Form (IPAQ).

RESULTS

Among 494 participants (78.8% response rate), the prevalence of self-reported depression was 15.2% (95%CI:12.0%-19.0%), and suicidal ideation was 7.7% (95%CI:6.2%-9.5%). Self-reported depression was significantly associated with perceived financial burden, physical inactivity, being senior student, perceived negative influence of night shifts, and non-self-determined motivation profile. Suicidal ideation was significantly associated with perceived financial burden and non-self-determined motivation profile. In the multivariable regression models, significant risk factors for self-reported depression were non-self-determined motivation (PR = 2.62, 95%CI:1.68-4.07), perceived financial burden (PR = 1.95, 95%CI:1.39-2.73), and vigorous level of physical activity (PR = 0.43, 95%CI:0.20-0.942). For suicidal ideation, non-self-determined motivation (PR = 2.33, 95%CI:1.13-4.80) and perceived financial burden (PR = 1.91, 95%CI:1.16-3.13) were significant risk factors.

STRENGTHS AND LIMITATIONS

The strengths of our study included a representative sample, a good response rate, and using a good depression screening tool. However, the PHQ-9 only allowed us to screen for depression, and the translation of the AMS and IPAQ into Vietnamese could potentially decrease these tools' validity.

CONCLUSION

The prevalence of self-reported depression and suicidal ideation in medical students is notably higher compared to the general population in Vietnam. Non-self-determined motivation and financial burden were the prominent risk factors for both the depression and suicidal ideation in medical students.