Polish medical students facing the pandemic-Assessment of resilience, well-being and burnout in the COVID-19 era

Food insecurity, dietary intake, and their impact on mental health among university students in Bangladesh

Objective

University students, a significant demographic within the adult population, may often face increased susceptibility to psychological distress and decreased resilience, probably due to the challenges of adjusting to a new life in university. Hence, this study aimed to explore how food insecurity and dietary intake are associated with psychological distress and resilience among university students in Bangladesh.

Methods

Information was collected from May to June 2024 among a sample of 450 students from Noakhali Science and Technology University, Noakhali district, Bangladesh, using a structured questionnaire assessing socio-demographic characteristics, food insecurity status, dietary intake, psychological distress, and resilience.

Results

Results revealed higher level of psychological distress and lower level of resilience among university students. Regression analysis (adjusted for socio-demographics) showed a significant positive association between food insecurity and psychological distress (b = 0.437, P = 0.005); however, food consumption score was negatively associated with psychological distress (b = -0.047, P = 0.012), indicating higher levels of distress among students experiencing higher food insecurity and lower dietary intake. On the other hand, resilience was observed to be negatively associated with food insecurity (b = -0.33, P = 0.003), suggesting that students facing higher food insecurity exhibited lower resilience levels.

Conclusion

The findings provided compelling evidence of the significant impact of food insecurity and dietary intake on mental health outcomes (psychological distress and resilience) among university students. Thus, addressing targeted interventions to improve university students' food insecurity and dietary intake to mitigate their psychological distress and resilience is of urgent need.

Experiences of healthcare professionals providing palliative care in home settings - a scoping review

BACKGROUND

The growing preference for home-based end-of-life care accords a dignified death for terminally ill patients. However, for healthcare professionals (HCPs) involved, this caregiving approach is embedded with unique psychosocial, practical and emotional stressors. Without sufficient support, HCPs face higher risks of moral distress, compassion fatigue, vicarious trauma, secondary traumatic stress and burnout-collectively known as the costs of caring-that precipitate depersonalisation and compromised patient care. Despite its far-reaching implications, current understanding of the costs of caring amongst HCPs in home-based settings remains remiss. Thus, we conduct a scoping review to investigate the experiences of HPCs providing home-based palliative care to terminally ill adult oncology patients.

METHODS

Outlined by the Systematic Evidence-Based Approach and PRISMA guidelines, searches for relevant articles published between 1st January 2000 and 1st October 2024 were performed on PubMed, Embase, Scopus, PsycINFO and CINAHL databases. Selected articles underwent concurrent and independent thematic and content analyses. Central themes and categories were extracted and merged, forming key domains that framed the discussion.

RESULTS

Of 5676 titles and abstracts screened, 543 full-text articles were reviewed. 20 full-text articles were analysed for inclusion. Four key domains emerged: (1) motivations to practice palliative care; (2) impact on personhood of HCPs (3) challenges faced by HCPs; and (4) support systems for HCPs.

CONCLUSION

Providing home-based palliative care to adult oncology patients is fulfilling for HCPs-fostering meaningful professional relationships with patients, a more holistic perspective of life and death and a heightened sense of personal accomplishment. However, HCPs may encounter dissonance amidst conflicts between their dominant beliefs and new experiences, leading to burnout, depersonalisation and poor care delivery that are further exacerbated by the costs of caring, if inadequately addressed. Longitudinal and accessible personalised and organisational support is key to sustaining HCPs' capacity to deliver compassionate and high-quality palliative care. The use of the Ring Theory of Personhood framework in this review provides an avenue for the structuring of such support systems.

Exploring Anxiety and Depression Among Medical Undergraduates in South Africa: A Cross-Sectional Survey

Background/Objectives: Globally, there has been an increase in the prevalence of anxiety and depression among university students, and medical students are no exception. Medical students are especially susceptible to these mental health challenges, primarily due to multifaceted stressors, which can significantly impact their academic achievements and future career. There is a pressing need for comprehensive research that not only investigates the prevalence of anxiety and depression among medical students but also explores strategies for developing effective mental health interventions and support systems that can enhance the well-being of medical students. Therefore, this study aimed to identify the prevalence and severity of anxiety and depression among medical students at a university in South Africa, evaluating the association of socio-demographic, student, and clinical variables with total general anxiety disorder (GAD-7) and patient health questionnaire (PHQ-9) scores. Methods: A survey-based quantitative cross-sectional study was conducted with 208 medical undergraduate students at a South African university. Participants who provided written consent completed GAD-7 and PHQ-9 questionnaires together with socio-demographic, student, and clinical variable information. The relationship between socio-demographic, student, and clinical variables and total GAD-7 and PHQ-9 scores was determined using the Mann-Whitney U test and Kruskal-Wallis H test. Correlation analysis was used to establish the relationship between total anxiety and depression scores. The threshold for statistical significance was set at p ≤ 0.05. Results: More than half of the participants were female (n = 130; 62.5%), single (n = 123; 59.1%), and belonged to the Pedi ethnic group. A majority of the students were Christian (n = 183; 88.0%), received a bursary (n = 183; 88.0%), and had a rural background (n = 155; 74.5%). However, a small percentage of students reported a history of psychiatric and chronic illnesses (n = 26; 12.5%) and previously received professional psychological support (n = 38; 18.3%). In this study, 38% (n = 79) of the participants reported GAD and 67.8% (n = 141) reported symptoms of depression. Significant associations (p <0.05) were observed between variables such as year of study, repeating a module, and history of psychiatric illness with total GAD-7 and PHQ-9 scores. Correlation analysis revealed a moderate positive correlation (rs = 0.400, df = 206, p < 0.001) between total GAD-7 and PHQ-9 scores. Conclusions: This study identified a high level of depression and anxiety among medical students and found a positive correlation between anxiety and depression scores. Addressing these mental health challenges is crucial not only for the well-being of the students but also for the future of healthcare, as the mental health of medical professionals directly impacts patient care.

The COVID-19 pandemic and adolescents' and young adults' experiences at school: A systematic narrative review

The COVID-19 pandemic upended the lives of adolescents and young adults across the globe. In response to the pandemic onset, educational institutions were forced to pivot to online learning, a new teaching and learning format for most secondary and university students. This systematic narrative review summarizes findings from 168 publications spanning 56 countries on students' educational outcomes and school climate as well as the internal assets and contextual supports that promoted academic well-being during the pandemic. Our findings suggest that young people commonly reported declines in their academic-related outcomes and school-based relationships due to the COVID-19 pandemic. Internal assets (e.g., intrinsic motivation and self-efficacy) and contextual supports (i.e., relationships with teachers, peers, and parents) promoted academic well-being during the pandemic. Next steps for research on young people's academic well-being during the pandemic are suggested.

Enhancing Professionalism Online (Netiquette) in Medical Schools: A Systematic Scoping Review

Background

The relaxing of COVID-19 pandemic restrictions has not seen the return to previous in-person teaching formats. As blended training continues to be used, there is emphasis on the need to better appreciate the expectations, etiquette, and professional code of conduct ("netiquette") surrounding online learning, especially in light of evidence that poor online professionalism compromises learning and clinical practice.

Objectives

This review seeks to map regnant netiquette guidelines in medical schools that will inform and provide preliminary recommendations for a clinically relevant framework.

Design

This study is a systematic scoping review (SSR).

Methods

Krishna's Systematic Evidence-Based Approach (SEBA)'s Constructivist ontological and Relativist epistemological lens was used to guide this SSR. The SEBA process involves 6 stages, including the Systematic Approach, Split Approach, Jigsaw Perspective, Funneling, Analysis of evidence-based and non-data-driven literature, and Synthesis of the SSR in SEBA.

Results

In total, 7941 abstracts were reviewed, 198 full text articles were evaluated, and 83 articles were included. The analysis of the results revealed 4 key domains: (1) current guidelines, (2) manifestations, (3) contributing factors, and (4) implications. This SSR in SEBA highlights variability and gaps in current guidelines and reveals the impact of sociocultural factors on breaches in netiquette. Unsurprisingly, contextual and clinical considerations shape the contributory factors impacting lapses in netiquette and their implications.

Conclusions

Based on the data accrued, this article proposes basic guidelines on netiquette and measures to support their effective employment. This includes curricular adaptations, methods of teaching and enhancing engagement with the students and faculty training. Drawing on prevailing studies, it also recommends methods of assessing netiquette, online professionalism, and the learning environment. Suggestions are also made for future areas of study.

Resilience, sleep quality and sleepiness in Peruvian medical students: a multicenter study

Background

Resilience can mitigate the negative impact produced by the COVID-19 pandemic. Medical students endure significant academic stress, so adjusting to sudden changes can present greater mental health challenges. The aim is to identify the level and prevalence of resilience and to know what are the educational variables and is sleep quality associated with resilience.

Methods

A cross-sectional study was conducted using an online questionnaire. The survey was elaborated in Google Forms and shared through social networks. The outcome was resilience, measured with the Connor Davidson Resilience Scale. Its association was assessed with sleep quality (measured with the Pittsburgh Sleep Quality Index), daytime sleepiness (measured with the Epworth Sleepiness Scale), and selected academic/sociodemographic variables. Generalized linear models were used to identify the association between the variables.

Results

Of 1277 participants, 35.7% experienced high resilience. Poor sleep quality and sleepiness were present in 88.4% and 36.0% of students, respectively. High resilience was associated with good sleep quality (PR:1.56; 95%CI: 1.34 - 1.83; p-value<0.001), absent sleepiness (PR:1.59; 95%CI: 1.32-1.91; p-value<0.001), male sex (PR: 1.21; 95%CI: 1.05-1.39; p-value 0.006), working (PR:1.14), having family responsibilities (PR: 1.36; 95%CI: 1.09-1.70; p-value 0.005) and spending more than 6 hours studying (PR: 1.35; 95%CI: 1.17-1.54; p-value<0.001).

Conclusion

4 out of 10 students presented high levels of resilience. The development of resilience depended on multiple individual and sociodemographic factors. These findings are important to support universities in developing resilience-building measures and strategies that can be implemented to mitigate the adverse pandemic event.

Impact of COVID-19 on medical students well-being and psychological distress

Background

Mental well-being is important for medical students to perform effectively. The COVID-19 pandemic posed different stressors to medical students increasing their vulnerability to distress and impaired well-being.

Aim

To assess the effect of the COVID-19 pandemic on the well-being of medical students and its relation with COVID-related psychological distress and fear as well as sleep quality.

Materials and Methods

We planned a cross-sectional study on medical students with the help of an online Google Form including sociodemographic data, medical students well-being index (MSWBI), Psychological Distress Scale, fear of COVID-19 Scale (FCV-19S), and Pittsburgh Sleep Quality Index (PSQI).

Results

48.13% of students reported higher distress and impaired mental well-being. Impaired well-being is correlated with COVID-related psychological distress, fear of COVID-19, and disturbed sleep quality. Regression analysis showed that joint family and sleep disturbances significantly predicted distress or poor well-being in medical students.

Conclusion

Almost half of the medical students revealed impaired mental well-being underlining the role of COVID-related stressors in worsening the psychological health of students. In this situation, it is important to take prompt measures to identify vulnerable students and help them.

Did Covid-19 make things worse? The pandemic as a push factor stimulating the emigration intentions of junior doctors from Poland: A mixed methods study

Covid-19 has challenged health systems around the world and increased the global competition for medical professionals. This article investigates if the pandemic and its management became an important push factor influencing the migration intentions of medical students and junior doctors and how this factor compared in importance to others. A mixed methods study-a survey and in-depth interviews-was conducted with final-year students at public medical universities in Poland, a country already suffering from a significant emigration of medical staff. The research demonstrated that the difficulties of the Polish healthcare system in dealing with Covid-19 were a factor that slightly positively influenced the emigration intentions of medical students and junior doctors. Nevertheless, the pandemic's influence was not decisive. Factors such as the socio-political situation in Poland (.440**) (including hate speech directed at doctors by politicians and patients), the participants' family situation (.397**), healthcare system organization (.376**), or the opportunity of pursuing a planned career path (.368**) proved more influential. Salary is still important but did not turn out to be among the decisive factors. This allows us to conclude that migration decisions of medical students have a very well-established basis that does not fundamentally change even under the influence of such dramatic situations as the pandemic. This conclusion has important implications for healthcare management and the ongoing discussion in migration studies on the evolution of push and pull factors in place and time.

Evaluation of COVID-19 Effect on Mental Health, Self-Harm, and Suicidal Behaviors in Children and Adolescents Population

OBJECTIVES

The impact of the COVID-19 pandemic on the psychological state of the under-18 population includes an increased risk of psychopathological symptoms development and exacerbation of already present psychiatric disorders. This study aimed to assess the prevalence of mental health problems in Polish children and adolescents with a focus on suicidal and self-harm behavior with the impact of the pandemic.

METHODS

The questionnaire collected demographic data, information regarding mental states and psychopathological symptoms, history of self-harm and suicidal behaviors, as well as the experience of psychological, and physical violence, and suicidal self-harm behaviors before and during the COVID-19 pandemic.

RESULTS

In the final analysis, 782 responses were included. Self-evaluation of general and mental health scores was significantly lower during the pandemic among children (both p < 0.001) and adolescents (both p < 0.001). Moreover, general and mental health scores were lower among adolescents compared to children before (both p < 0.001) and during (both p < 0.001) the pandemic. The frequency of seeking help because of mental health problems increased during the pandemic among children and adolescents, while no changes were observed in the prevalence of psychiatric hospitalizations in either of the populations (p = 0.317 and p = 1.00, respectively). Out of autoregressive behaviors among children during the pandemic period, only the frequency of thinking about death increased (p = 0.038). No suicidal attempts were undertaken by children in either of the evaluated time periods. The presence of all autoaggressive behaviors was greater among adolescents compared to children both before and during the COVID-19 pandemic (all p<0.05).

CONCLUSIONS

A subjective decrease in psychophysical well-being, an increase in the frequency of seeking mental health help during the pandemic, as well as an increased prevalence of depressive and anxiety symptoms were observed in the under-18 population as a potential consequence of the COVID-19 pandemic and related socioeconomic changes. The marked increase in self-harm behavior in the adolescent population (age > 12) and the marked increase in the frequency of death thinking in children (age ≤ 12) suggests the need for greater awareness and easier access to professional help from mental health specialists, particularly in a time of unprecedented stress and social isolation.

The impact of online education during the Covid-19 pandemic on the professional identity formation of medical students: A systematic scoping review

Evolving individual, contextual, organizational, interactional and sociocultural factors have complicated efforts to shape the professional identity formation (PIF) of medical students or how they feel, act and think as professionals. However, an almost exclusive reliance on online learning during the COVID-19 pandemic offers a unique opportunity to study the elemental structures that shape PIF and the environmental factors nurturing it. We propose two independent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA)s to map accounts of online learning environment and netiquette that structure online programs. The data accrued was analysed using the clinically evidenced Krishna-Pisupati Model of Professional Identity Formation (KPM) to study the evolving concepts of professional identity. The results of each SSR in SEBA were evaluated separately with the themes and categories identified in the Split Approach combined to create richer and deeper 'themes/categories' using the Jigsaw Perspective. The 'themes/categories' from each review were combined using the Funnelling Process to create domains that guide the discussion. The 'themes/categories' identified from the 141 included full-text articles in the SSR in SEBA of online programs were the content and effects of online programs. The themes/categories identified from the 26 included articles in the SSR in SEBA of netiquette were guidelines, contributing factors, and implications. The Funnelling Process identified online programs (encapsulating the content, approach, structures and the support mechanisms); their effects; and PIF development that framed the domains guiding the discussion. This SSR in SEBA identifies the fundamental elements behind developing PIF including a structured program within a nurturing environment confined with netiquette-guided boundaries akin to a Community of Practice and the elemental aspect of a socialisation process within online programs. These findings ought to be applicable beyond online training and guide the design, support and assessment of efforts to nurture PIF.

Resilience of undergraduate health sciences students during COVID-19: An integrative review

Background

COVID-19 pandemic placed pressure on global health systems, healthcare providers and undergraduate students in health sciences. Students experienced change in the teaching and learning as well as the clinical context resulting in increased stress levels. Resilience assisted students to adapt and develop competencies and effective coping mechanisms.

Aim

The purpose of this integrative review is to identify resilience of undergraduate students in health sciences during the COVID-19 pandemic.

Setting

Online platforms.

Methods

An integrative review was conducted with keywords: resilience, undergraduate students, health sciences and COVID-19. Three different searches were conducted for the time frame 2020-2022 on the relevant electronic data bases with full text articles. A total of 1665 records were identified and 49 potentially relevant articles were identified. Screening resulted in 34 articles that were analysed using the John Hopkins critical appraisal criteria.

Results

Four themes were identified: attributes of students' resilience, aspects enhancing the development of resilience, aspects hindering the development of resilience and recommendations to cultivate resilience.

Conclusion

Resilience is key to withstand the challenges in the global health system. The development of resilience in undergraduate health sciences students should be prioritised to ensure cognitive adaptability, effective coping skills and sufficient support.

Contribution

These findings can assist higher educational institutions to improve their undergraduate health science programs to cultivate resilient health care professionals.

What is well-being? A scoping review of the conceptual and operational definitions of occupational well-being

Well-being is a multifaceted construct that is used across disciplines to portray a state of wellness, health, and happiness. While aspects of well-being seem universal, how it is depicted in the literature has substantial variation. The aim of this scoping review was to identify conceptual and operational definitions of well-being within the field of occupational health. Broad search terms were used related to well-being and scale/assessment. Inclusion criteria were (1) peer-reviewed articles, (2) published in English, (3) included a measure of well-being in the methods and results section of the article, and (4) empirical paper. The searches resulted in 4394 articles, 3733 articles were excluded by reading the abstract, 661 articles received a full review, and 273 articles were excluded after a full review, leaving 388 articles that met our inclusion criteria and were used to extract well-being assessment information. Many studies did not define well-being or link their conceptual definition to the operational assessment tool being used. There were 158 assessments of well-being represented across studies. Results highlight the lack of a consistent definitions of well-being and standardized measurements.

Resilience, Positivity and Social Support as Perceived Stress Predictors among University Students

Since the COVID-19 pandemic, researchers have been trying to identify which personal resources can contribute to minimizing the mental health costs in students incurred due to the restrictions that disrupted safety and predictability in their academic lives. The aim of the study was to verify if and how individual factors (resilience and positivity) and socio-environmental factors (social support and nationality) allow prediction of the level of perceived stress. University students (n = 559) from Poland, Serbia, and Italy were surveyed using the Perceived Stress Scale (PSS-10), the Brief Resilience Scale (BRS), the Positivity Scale (PS), and the Interpersonal Support Evaluation List (ISEL-12). Personal resources-positivity, resilience, and support-were found to be positively interrelated and significantly associated with stress levels. Additionally, gender and nationality differentiated stress levels. A general linear model (GLM) showed that levels of perceived stress are best explained by resilience, positivity, tangible support, and gender. The results obtained can strengthen students' awareness of personal resources and their protective role in maintaining mental health, as well as contribute to the creation of prevention-oriented educational activities. Nationality was not a significant predictor of the level of perceived stress, which highlights the universality of examined predictors among university students from different countries and suggests that interventions aimed at enhancing these resources could benefit students across different cultural contexts.

Changes in alcohol consumption among medical students during the COVID-19 pandemic - results from POLLEK study

OBJECTIVES

Social distancing and remote learning as one of the ways to fight against COVID-19 pandemic have affected universities and changed the lifestyle of many students. Psychoactive substances use was one of the way to deal with the anxiety caused by these new settings. Studies published so far have not provided a clear answer on whether COVID-19 leads to changes in the structure of alcohol consumption among medical students. The presented study attempted to answer this question based on the data available from the POLLEK study.

MATERIAL AND METHODS

The study group included 3 separate groups of medical students (recruited in the following academic years: 2019/2020, 2020/2021, and 2021/2022) with a total number of 899 students. To assess the characteristics of alcohol consumption the authors used a Polish version of the Alcohol Use Disorder Identification Test (AUDIT).

RESULTS

Students surveyed during the lockdown lived in the family home much more often, reported good health, and declared consumption of a smaller number of alcoholic beverages. Their AUDIT scores were statistically significantly (p = 0.04) lower compared to the group surveyed before the pandemic (5 vs. 6, respectively). There were no significant differences in the AUDIT results between other study periods.

CONCLUSIONS

Lockdown due to COVID-19 pandemic might be associated with a decrease in alcohol intake among medical students. This may be due to a different place of residence of students, a family home rather than a dormitory. However, the debate on this topic seems to be still open. Int J Occup Med Environ Health. 2023;36(3):406-16.

Global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic: A meta-analysis

Objective

To estimate the global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic.

Methods

Embase, Ovid-MEDLINE, PubMed, Scopus, Web of Science, CINAHL, WHO COVID-19 databases, and grey literature were searched for studies from January 1, 2020, to August 22, 2022. Hoy's assessment tool was used to assess for risk of bias. Meta-analysis and moderator analysis was performed using the Generalized Linear Mixed Model with a corresponding 95 % confidence interval (95 % CI) adopting the random-effect model in R software. Between-study heterogeneity was measured using I² and τ² statistics.

Results

Overall, 44 studies involving 51,119 participants were identified. The pooled prevalence of low resilience was 27.0 % (95 % CI: 21.0 %–33.0 %) with prevalence among the general population being 35.0 % (95 % CI: 28.0 %–42.0 %) followed by 23.0 % (95 % CI: 16.0 %–30.9 %) for health professionals. The 3-month trend analysis of the prevalence of low resilience beginning January 2020 to June 2021 revealed upward then downward patterns among overall populations. The prevalence of low resilience was higher in females, studied during the delta variant dominant period, frontline health professionals, and undergraduate degree education.

Limitations

Study outcomes showed high heterogeneity; however, sub-group and meta-regression analyses were conducted to identify potential moderating factors.

Conclusions

Globally, 1 out of 4 people among the general population and health professionals experienced low resilience due to COVID-19 adversity. The prevalence of low resilience was twice as much among the general population compared to health professionals. These findings provide information for policymakers and clinicians in the development and implementation of resilience-enhancing programs.

Prevalence of burnout and its associated factors among medical students during COVID-19 pandemic in Indonesia: A cross-sectional study

Shifting learning process due to COVID-19 has led to increased burnout prevalence among medical students. Thus, this study aimed to assess burnout prevalence and its associated factors among Indonesian medical students during the COVID-19 pandemic. An online cross-sectional study was carried out among medical students in Malang, Indonesia. Burnout was assessed using the Maslach Burnout Inventory-Student Survey tool. Pearson's Chi-square was used to assess significant associations, and binary logistic regression was conducted to evaluate the relationships between the predictor variables and burnout. The difference of each subscale score was evaluated using an independent sample t test. This study analyzed 413 medical students with a mean age of 21.1 ± 1.4 years old. About 29.5% and 32.9% of students reported a high level of emotional exhaustion and depersonalization, respectively, resulting in 17.9% of burnout prevalence. Stage of study was the only sociodemographic factor independently associated with burnout prevalence (odds ratio = 0.180, 95% confidence interval = 0.079-0.410, p-values = 0.000). Preclinical students had significantly higher levels of emotional exhaustion (p-value = 0.004, d = 0.3) and depersonalization (p-value = 0.000, d = 1.1), and lower levels of personal accomplishment (p-value = 0.000, d = -0.5). Around one-sixth of the medical students experienced burnout during the COVID-19 pandemic, with preclinical students being more prone to have burnout. Future study with other adjusted confounding factors is needed to completely understand the issue and obtain immediate interventional strategies to reduce burnout among medical students.

Psychological distress among healthcare students in Poland from COVID-19 to war on Ukraine: a cross-sectional exploratory study

Objectives

Healthcare students went through a rough time in March 2022 due to extreme changes in the educational system (moving from online to stationary learning) and Ukrainian-Russian war circumstances. Our study aims to update knowledge about psychological distress and its impact on healthcare students in Poland after two years of the COVID-19 pandemic, followed by intense and political instability in Europe.

Methods

We conducted a cross-sectional study on healthcare students from Poznan University of Medical Sciences, Poland, from March to April 2022. The questionnaire included subjective retrospective 5-point Likert-scales ratings of anxiety, stress, and depression and self-reported information on various psychological distress predictors.

Results

The anxiety levels at the beginning of the COVID-19 pandemic were higher than in April 2022. There was no significant reduction in stress and depression. Females had higher initial anxiety levels than post-pandemic levels. Higher reported levels of anxiety, stress, and depression were significantly correlated with political instability in Eastern Europe (Spearman ranxiety = 0.178, rstress = 0.169, rdepression = 0.154, p ≤ 0.001, respectively). The concern about moving towards online education showed a significant association only with stress level (rstress = 0.099, p = 0.034). We also observed a positive correlation between anxiety, stress, and depression and deteriorating sleep quality (Spearman ranxiety,=0.325, rstress = 0.410, rdepression = 0.440, p < 0.001), the feeling of worsening relationships with family and peers (ranxiety = 0.325, rstress = 0.343, rdepression = 0.379, p < 0.001), and the sense of loss of efficient time management (ranxiety = 0.321, rstress = 0.345, rdepression = 0.410, p < 0.001).

Conclusion

Throughout the progression of the Ukrainian war and the COVID-19 pandemic, females reported improved (lower levels) levels of anxiety. Nevertheless, the current levels of self-reported anxiety post-pandemic remain alarming, while stress and depression levels remained unchanged. Mental, psychological, and social support activities are required for healthcare students, especially those away from their families. Time management, academic performance, and coping skills in relation to the additional stressors of war and the global pandemic require further research in this group of students.

Are medical students happy despite unhappy conditions: a qualitative exploration of medical student cohorts during disruptive conditions

BACKGROUND

Shortly after the World Health Organization declared the SARS-CoV-2 outbreak a worldwide pandemic, medical school governing bodies issued guidance recommending pausing clinical rotations. Prior to the availability of COVD-19 vaccines, many schools implemented exclusively online curriculums in the didactic and clinical years. These unprecedented events and paradigm changes in medical education could contribute to trainee burnout, wellness, and mental health.

METHODS

This single-institution study interviewed first, second, and third-year medical students from a medical school in the southwestern United States. A semi-structured interview was conducted with paper-based Likert scale questions rating perceived happiness were administered both at the time of the interview and one year later in order to understand how their student experience and happiness were impacted. In addition, we asked participants to describe any major life events they experienced since the first interview.

RESULTS

Twenty-seven volunteers participated in the original interview. Twenty-four from the original cohort participated in the one-year follow-up. Happiness as a sense of self and who you "should be" was challenged during the pandemic and changes in happiness over time were not systematic across classes. Stress was caused not only by the pandemic which was experienced by all, but by a tripartite state of individual circumstances, academic workload requirements, and the world at large. Primary themes from the interviews were clustered around the individual, learner, and future professional levels and focused on the primacy of relationships, emotional wellness, stress management, professional identity, and impacts of educational disruptions. These themes created risk factors for developing imposter syndrome. Students demonstrated resiliency across cohorts and were able to utilize a variety of strategies to achieve and maintain both physical and mental health, but the primacy of relationships both personally and professionally was noted.

CONCLUSION

Medical students' identities as individual persons, a learner, and future medical professionals were all impacted by the pandemic. The results from this study suggest that the COVID-19 pandemic and changes in the learning format and environment may create a new risk factor in the development of imposter syndrome. There is also an opportunity to re-consider resources to achieve and maintain wellness during a disrupted academic environment.

Factors affecting psychological health and career choice among medical students in eastern and western region of China after COVID-19 pandemic

Introduction

To unearth superior countermeasures that improve psychological health and upgrade the quality of employment for medical students in China in post-epidemic era, this study was designed to determine the possible factors affecting psychological status and future career choice of this population.

Methods

A cross-sectional observational study was carried out. Depression Anxiety Stress Scale-21 (DASS-21) and Insomnia Severity Index (ISI) were applied to measure psychological state. Chi-square and logistic regression analyses were adopted to filtrate related factors for psychological health and employment intention.

Results

A total of 936 medical students, including 522 from eastern universities and 414 from western universities, were enrolled in the study. Anxiety among students in China's western universities was higher than that in China's eastern universities (30.4% vs. 22.0%), but no differences in the occurrences of stress (11.4% vs. 13.4%), depression (28.7% vs. 24.5%) and insomnia (30.7% vs. 25.7%). Grades, academic ranking, household income, attitudes about COVID-19 were associated with the occurrence of psychological problems. In addition, major, education level, academic ranking, family income, and clinical experience may affect the choice of future employment location and employment income. Notably, household income affected by COVID-19 and the perception of epidemic prevention and control resulted in changes in future employment region and income. COVID-19 can lead medical students with psychological problems to have a negative attitude toward future employment. Encouragingly, multiple activities, namely, proactive consideration of employment, taking part in career planning training lectures and timely adjustment of career planning, were beneficial to the professional identity of medical students.

Conclusion

This study suggests that medical student psychology is influenced by COVID-19 and academic and financial pressures; actively coping with COVID-19 and making career planning in advance will contribute to optimizing future employment. Our findings provide a potent guideline for relevant departments to accurately adjust job deployment and for medical students to actively choose a career in the future.

Assessment of Medical Students Burnout during COVID-19 Pandemic

This study estimated the prevalence of burnout and its determinants among medical students at Jazan University during the COVID-19 pandemic. A total of 444 medical students completed an online survey containing the Maslach burnout inventory. The prevalence of burnout was 54.5%. Burnout reached its peak during the fourth year whereas it was the lowest in the internship year. Being a resident in mountain areas, being delayed in college-level, being divorced, and having divorced parents were all associated with an increased risk of burnout. During their time at medical school, students generally showed a trend of consistently high scores in the personal accomplishment subscale, a decreasing trend in the emotional exhaustion subscale, and an increasing trend in the depersonalization subscale. The most important predictive factor was having separated parents. Perceived study satisfaction appeared to be a significant protective factor in a dose-response manner. These findings suggest that burnout among medical students during the COVID-19 pandemic is a concern that should be monitored and prevented.

The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

This meta-analysis and systematic review aimed to evaluate the global prevalence and risk factors of mental problems (i.e., depression, anxiety, stress, sleep disorder, posttraumatic stress disorder (PTSD), burnout, psychological distress, and suicidal ideation) among medical students during the COVID-19 pandemic.

METHOD

We searched PubMed, Embase, Web of Science, psycARTICLES, PsycINFO, CNKI, and Wan Fang for studies on the prevalence of mental problems among medical students from January 1, 2020, to April 1, 2022. The pooled prevalence was calculated by random-effect models. We performed a narrative review to identify the risk factors.

RESULTS

The meta-analysis included 201 studies (N = 198,000). The prevalence of depression (41 %, 95 % CI, 37-45 %,), anxiety (38 %,95 % CI, 34 %-42 %), stress (34 %, 95 % CI, 27 %-42 %), sleep disorder (52 %, 95 % CI, 44 %-60 %), psychological distress (58 %, 95 % CI, 51 %-65 %), PTSD (34 %, 95 % CI, 22 %-46 %), suicidal ideation (15 %, 95 % CI, 11 %-18 %) and burnout (38 %, 95 % CI, 25 %-50 %) was high. The major risk factors were being female, being junior or preclinical students, exposure to COVID-19, academic stress, psychiatric or physical disorders history, economic trouble, fear of education impairment, online learning trouble, fear of infection, loneliness, low physical activity, low social support, problematic internet or smartphone use, and young age.

LIMITATIONS

Most studies were cross-sectional. Few studies provided a reasonable response rate, suggesting potential selection bias.

CONCLUSIONS

The study demonstrated a high prevalence and risk factors for mental problems during COVID-19, calling for mental health services. Our findings are valuable for college and health authorities to identify high-risk students and provide targeted intervention.

Is online learning during the COVID-19 pandemic associated with increased burnout in medical learners?: A medical school's experience

INTRODUCTION

The COVID-19 pandemic necessitated a shift to virtual curriculum delivery at Canadian medical schools. At the NOSM University, some learners transitioned to entirely online learning, while others continued in-person, in-clinic learning. This study aimed to show that medical learners who transitioned to exclusively online learning exhibited higher levels of burnout compared to their peers who continued in-person, clinical learning. Analysis of factors that protect against burnout including resilience, mindfulness, and self-compassion exhibited by online and in-person learners at NOSM University during this curriculum shift were also explored.

METHODS

As part of a pilot wellness initiative, a cross-sectional online survey-based study of learner wellness was conducted at NOSM University during the 2020-2021 academic year. Seventy-four learners responded. The survey utilized the Maslach Burnout Inventory, the Brief Resilience Scale, Cognitive and Affective Mindfulness Scale-Revised, and the Self-Compassion Scale-Short Form. T-tests were utilized to compare these parameters in those who studied exclusively online and those who continued learning in-person in a clinical setting.

RESULTS

Medical learners who engaged in online learning exhibited significantly higher levels of burnout when compared with learners who continued in-person learning in a clinical setting, despite scoring equally on protective factors such as resilience, mindfulness, and self-compassion.

CONCLUSION

The results discussed in this paper suggest that the increased time spent in a virtual learning environment during the COVID-19 pandemic might be associated with burnout among exclusively online learners, as compared to learners who were educated in clinical, in-person settings. Further inquiry should investigate causality and any protective factors that could mitigate negative effects of the virtual learning environment.

The impact of social support and stress on academic burnout among medical students in online learning: The mediating role of resilience

Background

As the COVID-19 pandemic continues, online learning and long-term isolation from social and clinical settings has exacerbated mental health problems and symptoms of academic burnout among medical students. However, few studies have discussed symptoms of academic burnout as a result of reduced social support, and increased stress among medical students during the process of online learning. To fill this gap, this study investigated the influencing factors and mechanism of academic burnout in medical students' online learning process. Both the positive inhibition effect of positive factors such as social support, and the negative aggravation effect of negative factors such as stress were explored, while the mediating and protecting role of resilience is also discussed.

Method

We collected survey data from a total of 817 medical students from a medical school in China who participated in online learning during the fall 2021 semester. An online questionnaire was sent to the students in January, 2022. Items adapted from the DASS Scale developed by Lovibond and Lovibond were used to measure medical students' stress levels. The perceived social support of medical students was assessed by the Gregory MSPSS. Resilience was evaluated by the 10-Item Connor–Davidson Resilience Scale (CD-RISC). Items from the Maslach Burnout Inventory–Student Survey (MBI-SS) were used to calculate students' academic burnout. Descriptive analysis, correlation analysis, hierarchical linear regression analysis and structural equation modeling were used to analyze the collected data.

Results

The results identified that in the context of online learning there was a positive correlation between medical students' stress and academic burnout, and their resilience played a partial mediating role. However, social support did not directly affect academic burnout, but inhibited the prevalence of academic burnout through resilience. In addition, stress was negatively related to resilience, while social support was positively related to resilience. Resilience was found to be negatively related to medical students' academic burnout in online learning.

Conclusion

The results of this study can provide a reference for the future development of appropriate educational strategies and coping measures to ameliorate the academic burnout of medical students.

Changes in Air-Pollution-Related Information-Seeking Behaviour during the COVID-19 Pandemic in Poland

Low air quality in Poland is a problem of particularly high urgency. Therefore, Poles must be aware of air quality levels, also during the COVID-19 pandemic. The study aimed to compare air-pollution-related information-seeking behaviour between the pre- and intra-pandemic periods as well as between the actual and theoretical machine-learning-forecasted intra-pandemic models. Google Trends search volumes (GTSVs) in Poland for air-pollution-related keywords were collected between January 2016 and January 2022. To investigate the changes that would have occurred without the outbreak of the pandemic, Seasonal Autoregressive Integrated Moving Average (SARIMA) machine-learning models were trained. Approximately 4,500,000 search queries were analysed. Between pre- and intra-pandemic periods, weighted mean GTSVs changed by −39.0%. When the actual intra-pandemic weighted mean GTSVs were compared to the intra-pandemic forecasts, the actual values were lower by −16.5% (SARIMA’s error = 6.2%). Compared to the pre-pandemic period, in the intra-pandemic period, the number of search queries containing keywords connected with air pollution decreased. Moreover, the COVID-19 pandemic might have facilitated the decrease. Possible causes include an attention shift towards everyday problems connected to the pandemic, worse mental health status and lower outdoor exposure that might have resulted in a lower intensity of non-pandemic-related active information-seeking behaviour.

Who Benefits from Fermented Food Consumption? A Comparative Analysis between Psychiatrically Ill and Psychiatrically Healthy Medical Students

Probiotic therapies and fermented food diets hold promise for improving mental health. Although in this regard psychiatric patients appear to benefit more than healthy individuals, no research has been performed to directly evaluate this hypothesis. The present study examined a cohort of medical students facing a stressful event, and some of the students reported suffering from chronic psychiatric diseases. The amount of fermented food consumption was calculated with the use of seven-day dietary records, while depressive and anxiety symptoms were assessed with the use of the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. In psychiatrically healthy medical students under psychological stress (n = 372), higher fermented food consumption was associated with more depressive and anxiety symptoms. In contrast, psychiatrically ill medical students (n = 25, 6.3% of all the participants) were found to present a negative association between the amount of fermented food consumed and the severity of depressive symptoms (adjusted β -0.52, 95% CI -0.85 to -0.19, p = 0.0042); however, this relationship was insignificant for anxiety symptoms (adjusted β -0.22, 95% CI -0.59 to 0.15, p = 0.22). A significant interaction was found between the consumption of fermented food and psychiatric diagnosis in predicting depressive symptoms (p = 0.0001), and a borderline significant interaction for anxiety symptoms (p = 0.053). In conclusion, psychiatrically ill people, but not healthy ones, may benefit from fermented food consumption in terms of alleviation of depressive symptoms. Our findings require cautious interpretation and further investigation.