Medical student perceptions of curricular influences on their wellbeing: a qualitative study

An Analysis of Students' Perceptions of Strategies to Improve Well-Being in Dentistry

INTRODUCTION

A number of papers have reported on stressors to students in the dental curriculum. This paper analyses perceptions of strategies to improve well-being among final-year dental students in a dental curriculum.

METHODS

A literature review was performed to create a question guide to explore issues of wellness and stress in a dental curriculum. Final-year dental students were invited to an interview using random sampling and issues related to strategies for well-being were analysed by an inductive-deductive approach.

RESULTS

Fourteen interviews were conducted, yielding three themes under the overarching domain of strategies to improve dental student well-being. Under the theme of well-being management, students wished for training on stress reduction for their personal well-being and guidance on communication, referral and mental health support to manage the well-being of colleagues and patients. The second theme, mentoring, covered peer support in the form of a 'buddy system' and sharing from recent graduates to help students gain practical and career advice about post-graduation challenges. Finally, suggestions for institutional support included providing in-house counsellors in the dental hospital with specialised knowledge about the unique concerns of dental students and clear leave of absence policies that treat mental and physical health equally to encourage help-seeking and reduce the fear of disclosure.

CONCLUSION

The experiences of final-year dental students were sampled to explore potential approaches to improve well-being in the dental school environment. Guided by these student perspectives, specific strategies have been implemented and recommended to improve the wellness support provided by the faculty for dental students.

Help-seeking in nursing and medical students: a concept analysis

Background

The prevalence of mental health issues in healthcare students is a growing concern. However, many healthcare students do not seek help because of the strong stigma attached to mental illness. This reluctance has been extensively researched, but a clear understanding of help-seeking behaviour among healthcare students remains elusive.

Aims

To clarify the concept of help-seeking in order to develop effective strategies aimed at encouraging help-seeking behaviour in students.

Method

Concept analysis of help-seeking behaviour among nursing and medical students in the context of mental health, based on Rodgers' evolutionary model.

Results

Attributes: (a) consulting a healthcare professional, (b) talking to family/peers/friends and (c) self-treatment. Antecedents: (a) self-awareness, (b) relationship and previous experiences with a help-provider, (c) social perception and (d) availability of university-offered help services. Barriers: (a) barriers specific to healthcare students, (b) misconceptions about mental healthcare services, (c) negative social perception, (d) cost and (e) culture. Consequences included: positive and negative consequences.

Conclusion

This concept analysis aimed to fill in the gap in concept-analysis research and to provide a new conceptualisation of help-seeking by examining subjective reports. The findings of this study will contribute to implementing effective incentives aimed at encouraging help-seeking behaviour in nursing and medical students.

A Qualitative Analysis of Students' Perceptions and Experiences of Stressors and Well-Being in Dentistry

INTRODUCTION

Well-being is increasingly regarded as an integral component of a graduating dentist's professional responsibility, yet studies demonstrate significant levels of stress and poor mental health in the dental student population. The aim of this qualitative study was to explore final-year dental students' perceptions of stressors in dentistry and their experiences of managing their individual well-being and supporting the well-being of their colleagues and patients.

METHODS

A literature search was performed to guide the development of an interview framework which included questions centred around three higher domains based on self, peers and patients. Participants were randomly sampled and the interviews audio recorded and transcribed verbatim. An inductive-deductive approach was adopted for thematic analysis of the results.

RESULTS

Fourteen interviews were conducted, revealing four themes and 15 subthemes. Students were acutely aware of poor well-being symptoms amongst themselves and their peers. Treating dental patients with mental illness was common but some students expressed uncertainties in managing these patients. The key stressors were assessments and clinical stress. Students frequently sought support from peers and half had received professional help. Barriers to approaching faculty staff were identified. The role of stigma in preventing students from openly sharing their well-being experiences was discussed.

CONCLUSION

A range of curricular and clinical stressors, and potential sources of support to manage these stressors, have been explored from the perspectives of final-year dental students. From these experiences, action points have been proposed to address knowledge gaps and enhance faculty-level wellness support for dental students.

Factors on medical clerkship students' quality of life: A survey study

Introduction

Due to the higher demand for healthcare provision in Indonesia, increasing the number of medical schools in Indonesia was highly encouraged. Meanwhile, medical students were considered a susceptible population to a variety of issues that negatively impact their quality of life (QOL) in comparison to the general community.

Objectives

The study aims to assess the QOL of Indonesian medical students during the clinical clerkship program (years 4-5) of their medical training while also exploring the association between the results and their ongoing rotation.

Methods

The survey was conducted online to 311 students at a private medical school in Jakarta using the Indonesian version of WHOQOL-BREF. Participants' characteristics, sleep duration, physical activity, and smoking history were also assessed to see if there was any association. Results: 82% of 311 registered clerkship students responded to the survey. In terms of overall QOL, being in a major department, 7-9 h of sleep duration, and owning a private vehicle increased the QOL.

Conclusion

This study suggested that medical schools' policies may consider sleep duration, travel time, transportation-related infrastructure, and social-related infrastructure to underpin students' social relationships and, afterward, improve their QOL in intangible ways.

Librarian-Led Assessment of Medical Students' Evidence-Based Medicine Competency: Facilitators and Barriers

Introduction

We must ensure, through rigorous assessment that physicians have the evidence-based medicine (EBM) skills to identify and apply the best available information to their clinical work. However, there is limited guidance on how to assess EBM competency. With a better understanding of their current role in EBM education, Health Sciences Librarians (HSLs), as experts, should be able to contribute to the assessment of medical student EBM competence. The purpose of this study is to explore the HSLs perspective on EBM assessment practices, both current state and potential future activities.

Methods

We conducted focus groups with librarians from across the United States to explore their perceptions of assessing EBM competence in medical students. Participants had been trained to be raters of EBM competence as part of a novel Objective Structured Clinical Examination (OSCE). This OSCE was just the starting point and the discussion covered topics of current EBM assessment and possibility for expanded responsibilities at their own institutions. We used a reflexive thematic analysis approach to construct themes from our conversations.

Results

We constructed eight themes in four broad categories that influence the success of librarians being able to engage in effective assessment of EBM: administrative, curricular, medical student, and librarian.

Conclusion

Our results inform medical school leadership by pointing out the modifiable factors that enable librarians to be more engaged in conducting effective assessment. They highlight the need for novel tools, like EBM OSCEs, that can address multiple barriers and create opportunities for deeper integration of librarians into assessment processes.

Reflections on teaching and learning during the omicron wave of the COVID-19 pandemic and economic inflation

The pandemic and the rising living costs have affected teaching and learning practices. These changes have impacted teaching faculty and students alike. This article is an analytical reflection of our experiences of teaching and learning during the omicron wave of the pandemic and rising economic inflation. This paper highlights some of our key observations. The reflective process has challenged some of our preconceptions. It has also helped highlight some questions and contradictions on teaching and learning in this context which may provide a reference for future research.

A systematic review and meta-analysis of studies exploring prevalence of non-specific anxiety in undergraduate university students

BACKGROUND

Anxiety is a common mental health problem in the general population, and is associated with functional impairment and negative impacts upon quality of life. There has been increased concern about university students' mental health in recent years, with a wide range of non-specific anxiety rates reported worldwide in undergraduate university students. We aimed to explore prevalence of non-specific anxiety in undergraduate university student populations.

METHODS

Four databases were searched to identify studies published between 1980 and 2020 which investigated prevalence of non-specific anxiety in undergraduate university students. Each study's quality was appraised using a checklist. Sub-analyses were undertaken reflecting outcome measure utilized, course of study, location of study, and whether study was before or during the COVID-19 pandemic.

RESULTS

A total of 89 studies - representing approx. 130,090 students-met inclusion criteria. Eighty-three were included in meta-analysis, calculating a weighted mean prevalence of 39.65% (95% CI: 35.72%-43.58%) for non-specific anxiety. Prevalence from diagnostic interview studies ranged from 0.3%-20.8% 12-month prevalence. Prevalence varied by outcome measure used to assess non-specific anxiety, the type of course studied by sample, and by study location. In half the studies, being female was associated with being more likely to have higher non-specific anxiety scores and/or screening above thresholds. Few of the included studies met all quality appraisal criteria.

CONCLUSION

The results suggest that approximately a third of undergraduate students are experiencing elevated levels of non-specific anxiety. Results from sub-analyses have identified some methodological issues that need consideration in appraising prevalence in this population.

Medical students describe their wellness and how to preserve it

BACKGROUND

Despite widespread efforts to create wellness programming in medical schools, there is a paucity of literature examining students' perception of wellness and perceptions of these programs. With the inaugural class at the Arizona campus of Mayo Clinic Alix School of Medicine (MCASOM-AZ), an opportunity arose to establish an empirically evaluated wellness curriculum that most inclusively and effectively enables medical students to flourish for years to come. The initial wellness offerings included mental health, academic success, and disability services, curriculum-embedded seminars, wellness committee driven programming, and student-proposed wellness activities. We aimed to improve the relevance and impact of medical school wellness curricula by soliciting in-depth and longitudinal perspectives of medical students themselves. As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students.

METHODS

Employing a mixed methods analysis of qualitative and longitudinal quantitative data, first- and second-year students at a MCASOM-AZ were invited to respond to an anonymous, online year-long survey (baseline, six months and 12 months) during the 2018-2019 academic year and participate in a structured, in-depth and in-person, peer-to-peer interview about their conceptions of wellness and the MCASOM-AZ wellness curriculum and resources. Qualitative data was coded for themes using thematic analysis strategies by independent raters.

RESULTS

Nearly half of eligible students completed the baseline survey,1/3 completed all 3 time-points, and 1/5 participated in an in-depth interview. Participant age, gender, and year of school were representative of the larger student body. Although individual conceptions varied, Wellness was consistently highly valued. Family, Academic Performance, and Friends emerged as most important to well-being across time-points. Academic work arose as the largest barrier to wellness. Analysis of qualitative data revealed five themes. Despite individual differences in approaches to wellness, wellbeing was interrelated to the learning environment; mandatory wellness efforts that didn't address the medical culture met with skepticism.

CONCLUSIONS

Interview responses provided understanding and context by which to interpret questionnaire responses. Academics was critical to students' identity and wellness, while also the largest barrier. Suggested curricular improvements include restructuring academic work, seamlessly integrating wellness within coursework, and offering optional individualized approaches.

Supporting medical students to support peers: a qualitative interview study

BACKGROUND

Students may be the first to recognise and respond to psychological distress in other students. Peer support could overcome medical student reluctance to seek help despite their high rates of mental ill-health. Yet, despite the adoption of peer support programs, there is little evidence of impact on students. Peer support programs may assume that medical students accept and view peer support positively. We explored these assumptions by asking students about their experiences and views on peer support.

METHODS

Qualitative semi-structured interviews exploring peer support experiences and views on peer support were conducted with ten medical students at two contrasting medical schools. Informed by a constructivist stance, interview transcripts underwent thematic analysis.

RESULTS

Three groups of themes were identified: participants' experiences of peer support encounters, concerns about providing support, and views on students' roles in peer support. Participants readily recalled signs of peer distress. Encounters were ad hoc, informal, and occurred within relationships based on friendship or by being co-located in the same classes or placements. Concerns about initiating and offering support included lack of expertise, maintaining confidentiality, stigma from a mental health diagnosis, and unclear role boundaries, with implications for acceptance of student roles in peer support.

CONCLUSIONS

Our study emphasised the centrality of social relationships in enabling or discouraging peer support. Relationships developed during medical studies may anticipate the collegial relationships between medical professionals. Nevertheless, only some students are willing to undertake peer support roles. We suggest different strategies for promoting informal peer support that can be offered by any student, to those promoting formal support roles for selected students. Future research focusing on the impact for both the students who receive, and on the students who provide peer support is called for.

Exploring the preconception of the first year of medical students on medicine before entering medical school

PURPOSE

First-year students can form a preconception based on life experiences before entering college and identifying learners' existing characteristics can be useful foundation data for curriculum development. This study examines what preconceptions freshman students had about medicine before entering medical school.

METHODS

A total of 110 first-year students were asked about what preconceptions they had about "medicine". A total of 1,124 data were used in the content analysis method.

RESULTS

The results were extracted into 5, and 12 twelve categories. On the theme of "scientific discipline", the knowledge students had about general health was based on scant expertise and little evidence. Students perceived medicine as Western and scientific, considering Korean traditional medicine as unscientific. Students believed that "medical practice" should be a "disease treatment" and "patient-centered" approach rather than a "social responsibility". In "the role of the doctor", students were concerned about the doctor's being financially stable on the positive side, and about the high-intensity workload on the negative side. In "medical education", students believed that studying medicine would be "hard and difficult" because of the "importance of memorizing" and "extensive study load". In "specialty stereotype", students had biases that were mostly concentrated on "psychiatry" and "surgery".

CONCLUSION

Perception of "medicine" has been revealed to a varied range of themes, but some have been inaccurate or unrealistic. These prejudices and groundless beliefs have a gap with the learning outcomes that students should achieve in the curriculum, and these preconceptions seem to have been influenced by South Korea's unique cultural context.

Risk Factors Associated With Increased Ethically Challenging Situations Encountered by Veterinary Team Members During the COVID-19 Pandemic

Ethically challenging situations (ECS) are commonly encountered in veterinary settings. The number of ECS encountered by some veterinary team members may increase during a crisis, such as the COVID-19 pandemic. This study aimed to determine the risk factors for experiencing an increase in the frequency of ECS in the months following the beginning of the COVID-19 pandemic, utilizing data from a global survey of veterinarians, veterinary nurses and animal health technicians collected from May to July 2020. In this study, descriptive analyses were performed to characterize veterinary team members who responded to the survey (n = 540). Binomial logistic regression analyses were performed to determine factors associated with an increase in ECS encountered since the beginning of the COVID-19 pandemic. Being a veterinary nurse or animal health technician, working with companion animals, working in the USA or Canada, and being not confident or underconfident in dealing with ECS in the workplace were factors associated with an increase in ECS encountered since the beginning of the COVID-19 pandemic. Results suggest a need to explore the ECS encountered by veterinary team members, particularly veterinary nurses and animal health technicians working in companion animal practice, in depth. Identification of risk factors may facilitate better preparation of veterinary team members for managing ECS, and minimizing the negative impact of ECS on the well-being of those who care for animals.

It's what you do, not the way you do it - online versus face-to-face small group teaching in first year medical school

BACKGROUND

Major disruptions imposed on medical education by the COVID-19 pandemic and the rapid shift to online teaching in medical programs, necessitated need for evaluation of this format. In this study we directly compared knowledge outcomes, social outcomes, and wellbeing of first year student small group teaching in either face to face (f2f) or online format.

METHODS

At the end of the first course of our medical program, students were invited to participate in an online questionnaire with 10 quantitative items and 1 qualitative item. These were analysed using Factor Analysis Pattern Matrix and linear regression to group items and assess relatedness. Qualitative responses were thematized using Qualtrics software (Qualtrics, Provo, UT, USA). Summative assessment results were compared, both between current cohorts to historical cohorts.

RESULTS

From a cohort of 298 students there was a 77% response rate. Overall, there were no differences in knowledge gains, either between groups or when compared to historical cohorts. Questionnaire items fell reliably into groups that related to either learning outcomes, social outcomes, or wellbeing. Independent T tests showed that format for teaching (online versus f2f) had an impact on social outcomes but no direct impact on learning outcomes. Linear regression revealed that the social outcomes have a direct impact on wellbeing and almost the double the impact on learning outcomes than mode of learning i.e.. F2f or online (β = .448 and β = .232 respectively).

CONCLUSION

In this study, we were able to show with statistical strength that social outcomes for students such as engaging with peers and facilitator, contributing to the group, and making friends have a direct impact on wellbeing and indirectly impact learning outcomes (such as motivation, satisfaction, integration of knowledge). In a rapidly changing educational landscape, in our opinion, it is vital that these aspects are a focus of design and delivery of medical education. The data from this study supports the notion that activity design and the expertise of the teacher in facilitating the small group activities, has greater impact than the mode of educational delivery itself on students' learning processes.

Anatomy education for medical students in a virtual reality workspace: A pilot study

The COVID-19 pandemic has posed a challenge for many medical schools, as they have had to adjust their curricula into an online format. This was particularly problematic for anatomy courses as in person dissections have historically been preferred for providing students with a three-dimensional learning environment. In this study, we aim to share our experience with conducting anatomy lectures for medical student using a virtual reality (VR) workspace. Additionally, we discuss the advantages of using VR and expand on how it may be used to improve students' understanding of anatomy in comparison to various other online lecture formats. To do this, we utilized a post-lecture survey to gain feedback from the medical students that participated in a VR anatomy workspace. We found that many of our participants expressed that having access to their course material from anywhere and anytime via a virtual space, and being able to manipulate anatomical structures by moving and modifying them provided the student with a strong advantage. Although there are still limitations, we hope that our experience will assist other anatomy teachers with improving their lecture methods, especially during the pandemic.

Frequency, Stressfulness and Type of Ethically Challenging Situations Encountered by Veterinary Team Members During the COVID-19 Pandemic

Ethically challenging situations (ECS) are common in veterinary settings and can lead to moral stress. However, there is no published information about how a global pandemic affects the frequency and types of ECS encountered by veterinary team members. An online mixed methods survey was developed to determine the frequency, stressfulness and types of ECS experienced by veterinarians, animal health technicians and veterinary nurses since the advent of the global COVID-19 pandemic in March 2020. Responses from 540 veterinary team members from 22 countries were analyzed. With the advent of the COVID-19 pandemic, the median frequency of ECS encountered by respondents increased from several times per month to several times per week (Spearman Rank Correlation 0.619, P < 0.0001). The most common ECS (encountered at least several times per week) were: challenging decisions about how to proceed when clients have limited finances (64.4%), conflict between personal well-being and professional role (64.3%), conflict between the interests of clients and the interests of their animals (59.6%). These were followed by challenging decisions about what counts as an essential veterinary service (48.1%); conflict between well-being of family/household members and professional role (46.3%); and challenging decisions about whether to perform non-contact veterinary visits (46.3%). The most stressful ECS (reported to be very or maximally stressful) were: conflicts between the interests of clients and the interests of their animals (50.2%), other (42.9%), conflicts between the interests of my employer and my own interests (42.5%), challenging decisions about how to proceed when clients have limited finances (39.4%), conflict between personal well-being and professional role (38.0%), and conflict between well-being of family/household members and professional role (33.6%). Thematic analysis of free-text responses revealed biosecurity, client financial limitations, animal welfare, working conditions, and client relations as prominent themes. This is, to the best of our knowledge, the first study to describe the impacts of the pandemic on ECS experienced by veterinary teams globally. It identifies an increase in the frequency of ECS associated with the COVID-19 pandemic, and a number of stressors unique to the pandemic. We identified a number of resources and strategies that may help veterinary team members navigate ethical challenges that may emerge in their daily work, as well as in the context of global crises.