Impact of Providing Peer Support on Medical Students’ Empathy, Self-Efficacy, and Mental Health Stigma

Background: Peer-support programs in medical school can buffer feelings of inadequacy, anxiety, social isolation, and burnout, drawing upon the benefits of near-peer-support resources. This study examined the effects of providing support to students in a medical school peer-support program. Methods: Using a pre-post, quasi-experimental study design, the investigators surveyed medical students who were peer supporters in their second through fourth years of medical school with four measures assessing (1) empathy, (2) self-efficacy, (3) mental health stigma, and (4) likelihood to assist peers with mental health problems to examine if serving as a volunteer peer supporter had any effect. Participants included 38 medical students that were actively enrolled peer supporters during the 2020–2021 year at a United States allopathic medical school. Results: Medical students who participated as peer supporters were found to have higher ratings of empathy scores (Z = −1.964, p = 0.050, r = 0.34) and self-efficacy scores (Z = −2.060, p = 0.039, r = 0.35) after participation in the program. No significant changes were noted for mental health stigma or likelihood to assist peers with mental health problems. Discussion: Peer-support programs present a low-cost, sustainable modality to promote wellbeing in medical students. There is a growing body of literature documenting the benefits of peer-support services. This brief, novel study examined the effects of providing peer support on the peer supporters and found higher self-reported ratings of empathy and self-efficacy after participation. These findings underscore peer-support programs as a valuable wellness resource not only for medical students who use the services but for those who provide them as well.

Effects of voluntary attendance patterns on first-year medical students' wellness and academic performance during COVID-19

There is increasing evidence that attendance is not a reliable predictor of academic performance, which invites the question of whether attendance may have alternative positive effects such as increased student wellness. While conducting an observational cohort study on the relationship of attendance to performance and wellness, the COVID-19 pandemic lockdown changed the ability of students to attend class. Matriculating medical students were recruited to participate at the beginning of their first year in August 2019. In-person attendance was collected prospectively until the lockdown began in March 2020. This was then correlated with performance on course final examinations and responses to two separate incidences of a survey on stress, burnout, social isolation, and loneliness. The first survey was deployed January through February 2020 (pre-COVID) and the second June 2020 (during COVID lockdown). Attendance declined across the year (76.0%-25.0%). There was a small positive correlation of attendance to performance in module 1 (r = 0.235, P = 0.035) with none in the remaining two modules (P = 0.870, P = 0.410). The high attenders at the time of the lockdown had no decline in their performance when attendance was no longer possible. Attendance negatively correlated with stress and loneliness but not with the remainder of the wellness metrics. There was no significant change in any of the wellness metrics between the pre-COVID and during COVID time points. While the data support the conclusion that attendance is not required to maintain performance in this population, these data suggest a small protective effect against stress and loneliness.

Effects of Voluntary Attendance Patterns on First Year Medical Students’ Wellness During COVID‐19

The COVID‐19 pandemic interrupted all in person activities at the UCF College of Medicine (CoM) M.D. program in March 2020. For the remainder of the academic year, all students were required to adopt to a new learning environment where all aspects of the M.D. program were delivered in an online platform. An ongoing study was taking place to evaluate how voluntary attendance at non‐mandatory sessions affected performance and wellness. The students in this study who had been attending non mandatory in‐person sessions were now only given the option of watching pre‐recorded sessions online. The study investigators hypothesized that this change would affect the wellness of the students who were attenders prior to the pandemic more so than then non‐attenders.

This was an observational cohort study in which prospectively collected attendance at non‐mandatory sessions during the first year of the MD program was correlated with responses to a wellness survey deployed pre‐ and post‐ the onset of the pandemic. The 69‐item survey was adapted from published and validated instruments: Graduate Stress Inventory – Revised (GSI‐R), Modified School Burnout Inventory, “Healthy Days Measure” (CDC HRQOL‐4), Pearlin Mastery Scale (Mastery), Multidimensional Scale of Perceived Social Support (MSPSS), De Jong Gierveld 6‐Item Loneliness Scale and Lubben Social Network Scale – 6 item (LSNS‐6). Multiple regression and Poisson regression analysis was performed as appropriate to predict participants wellness based upon attendance while controlling for collected demographics.

Eighty‐two students participated in the larger study and of those, 44 responded to the pre‐pandemic survey. Attendance was associated with lower stress overall as measured by the GSI (β= ‐0.331, p= 0.048, R²= 0.217) including lower scores in the Family Stress subscale (B= ‐0.01, p= <0.001). Loneliness also decreased with increasing attendance (B= ‐0.015, p= 0.008). Increase in attendance was associated with fewer days unable to do normal activities due to poor physical or mental health, as measured by the CDC HRQOL‐4 (β= ‐0.339, p= 0.043, R²= 0.216). Thirty‐nine students participated in the post‐pandemic survey, where again attendance was associated with lower stress according to the GSI (β= ‐0.482, p= 0.029, R²= 0.203). Thirty‐one students completed both surveys for paired analysis. Increase in attendance before COVID‐19 was associated with a decrease in poor mental health afterwards as measured by the CDC HRQOL‐4 (B= ‐0.007, p= 0.004). The rest of the regressions did not demonstrate an association between attendance and other aspects of wellness pre‐ or post‐ the pandemic.

Attending non‐mandatory sessions was associated with a decrease in graduate stress both pre and post COVID‐19 lockdown. Most other results were not statistically significant, elucidating that there may be no major differences between attender's and non‐attender's experience of burnout or social isolation.

Diamond based photonic crystal microcavities

Diamond based technologies offer a material platform for the implementation of qubits for quantum computing. The photonic crystal architecture provides the route for a scalable and controllable implementation of high quality factor (Q) nanocavities, operating in the strong coupling regime for cavity quantum electrodynamics. Here we compute the photonic band structures and quality factors of microcavities in photonic crystal slabs in diamond, and compare the results with those of the more commonly-used silicon platform. We find that, in spite of the lower index contrast, diamond based photonic crystal microcavities can exhibit quality factors of Q=3.0x10(4), sufficient for proof of principle demonstrations in the quantum regime.

Intraobserver and interobserver reliability of the R/D score for evaluation of iris configuration by ultrasound biomicroscopy, in patients with pigment dispersion syndrome

The work has been presented at The Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, Fort Lauterdale, Florida, May 1999.

PURPOSE

To evaluate inter- and intraobserver variability of the R/D score in assessing the iris configuration in Pigment Dispersion Syndrome patients.

METHODS

Fifty-seven high-resolution ultrasound biomicroscopy images were obtained by a single ophthalmologist. All images were examined twice by each of three ophthalmologists, the second assessment being at least 2 weeks after the first. Each observer was masked to their colleagues' and their previous measurements. R/D scores were calculated at each examination. Agreement between and amongst observers was assessed using Bland-Altman plots. In addition, the R/D scores were categorised and reassessed using the Kappa statistic.

RESULTS

Intraobserver variability was small, the average differences between first and second scores of each observer being less than 0.01 units. Agreement within observers was 89% or higher, with Kappa values of 0.8 or higher, indicating almost perfect agreement. Interobserver variability was, however, greater. Although there was substantial agreement between two of the observers (87% agreement, first assessment; 80%, second assessment with respective kappa statistics of 0.78 and 0.66), they only moderately agreed with the other observer (kappa statistics between 0.55 and 0.68).

CONCLUSIONS

This study suggests that when using R/D scores to demonstrate changes in iris configuration, assessments should preferably be made by the same observer.

Problems and risks of unsolicited e-mails in patient-physician encounters in travel medicine settings

BACKGROUND

International travel and use of modern information technology are expressions of modern life style. Seeking on-line travel health advice via E-mail for preventive (teleprevention) or diagnostic reasons may become increasingly popular among patients with financial resources and Internet access. This study was undertaken to compare the behavior of travel clinic or tropical medicine physicians and other providers of travel-related medical information services toward unsolicited E-mails from fictitious patients in pretravel and post-travel scenarios. We also wanted to test the potential of E-mail advice for preventive medicine (teleprevention), and to find out how the "Good Samaritan Law" is observed.

METHODS

Two different E-mails were posted to E-mail addresses of 171 physicians (members of travel health and/or tropical medicine societies) and services offering advice on travel health issues identified by an AltaVista search. These E-mails, from two different fictitious travelers, were asking for advice regarding malaria prophylaxis in a pretravel scenario and describing symptoms suggesting acute malaria.

RESULTS

Of the contacted addresses 43.3% and 49.7% respectively, replied to the pre- and post-travel E-mail. Of those suggesting antimalarial chemoprophylaxis in the pretravel scenario, 13.2% proposed inadequate regimens, and at least 3.5% of the post-travel replies were inappropriate. The "Good Samaritan Law" was observed by a significant number of physicians.

CONCLUSION

Both patients and physicians have to be aware of the limitations of E-mail communication. Guidelines protecting physicians against legal and ethical consequences of this new communication technology are urgently needed.

Peer reviewed: facing the challenges of a service economy

The environmental impacts of the large-and growing-service-based sector of the U.S. economy are poorly characterized.

Independent regulation of prostaglandin production and the stress response in human fibroblasts

The stress, or heat shock response of eukaryotic cells is characterized by dramatic changes in the metabolism of responding cells, most notably the increased synthesis of a group of proteins known as heat shock proteins. In this study, we examined the relationship of prostaglandin synthesis/release to the stress response. Stress protein synthesis was induced with sodium arsenite, and prostaglandin E2 and prostacyclin (measured as 6-keto PGF1 alpha) levels were determined by enzyme immunoassay. The stress response was monitored by the incorporation of [35S]methionine and separation of protein by one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Prostaglandin synthesis and the stress response were both induced by sodium arsenite. However, aspirin, a cyclooxygenase inhibitor, inhibited arsenite-induced prostaglandin synthesis but did not inhibit stress protein synthesis. Conversely, the calcium ionophore A23187 also stimulated prostaglandin synthesis, but did not induce the stress response. The results of this study indicate that sodium arsenite, a stress response inducer, stimulates prostaglandin production, but this appears to be a correlative rather than causative occurrence in the stress response. Determination of the cytotoxicity of arsenite indicated a high correlation of stimulation of prostaglandin release with cytotoxicity.

Phase-shifted surface-acoustic-wave resonator

The spatial distribution of the surface-acoustic-wave (SAW) intensity across a phase-shifted transducer-resonator is studied. A coupled-mode analysis of this structure shows that a highly confined mode can be excited in a pi/2 shifted resonator. Experimental verification of this conclusion was obtained in a LiNbO(3) pi/2 shifted resonator, in which the SAW intensity was measured. The concentration factor (the ratio of the maximum to average SAW intensity) can be ~10 for reasonably long resonators.

Polarization discrimination properties of Bragg-reflection waveguides

Finite-clad Bragg-reflection waveguides are analyzed by a leaky-wave approach. The eigenvalue equation for TE and TM propagation is derived, and approximate expressions are given for the loss coefficient. Proper design of these structures is shown to lead to high polarization discrimination.

Plane-wave spectrum approach for tilted waveguides

Scattering of guided modes from an abruptly terminated waveguide is analyzed through an integral-equation formulation. First the boundary-value problem for a plane-stratified waveguide with arbitrary profile is reduced to a canonical system of surface integral equations. A Born-type iterative procedure is then employed to obtain a tractable solution of the scattering field at the termination. The specific choice of a tilted planar termination renders an explicit closed-form expression for the first Born approximation, represented by the plane-wave spectrum of the incident modal field modified by the appropriate Fresnel coefficient. Thus previous ad hoc formulations can be recovered as limiting cases of the suggested rigorous expansion scheme.

Modal coupling in tilted-mirror waveguide lasers and amplifiers

Tilted-mirror facets have been introduced as a design alternative to antireflection coating for waveguide structures that require low facet reflectivity. We show that tilted-mirror facets with finite reflectivity can induce significant intermode coupling in semiconductor lasers and optical amplifiers. We describe the effect of tilt-induced intermode coupling on the cavity modes using a simple model and discuss the implications of our results on the design of tilted-mirror integrated-optical lasers and amplifiers.

Saturable nonlinear dielectric waveguide with applications to broad-area semiconductor lasers

Self-focusing in a passive dielectric waveguide with a saturable nonlinearity is studied. The eigensolutions constitute a good approximation to the lateral modes of broad-area semiconductor lasers under low-duty-cycle pulsed conditions. The laser modes are predicted to consist of adjacent filaments coupled in phase, leading to a single-lobed far field, and to be stable with increased current injection above saturation intensity. The ultimate filament spacing is inversely proportional to the threshold gain, and thus wider filaments are expected in low-threshold broad-area lasers.

Electrophysiological assessment of aphakic cystoid macular oedema

Focal electroretinograms (FERG), pattern electroretinograms (PERG), and visual evoked potentials (VEP) were studied in a group of 30 aphakic patients with cystoid macular oedema (ACME). When compared with a control group of age-matched aphakics, 35% of patients were found to have abnormal FERG responses and 53%--over half of whom had normal FERG responses--showed abnormal PERG amplitudes. Although most of the patients had associated optic disc leakage, VEP latencies were normal in 26 out of 30. These results may explain the more severe visual loss seen in some ACME patients where the ophthalmologically visible retinal changes do not seem sufficient to explain such reduction in vision.

Confocal unstable-resonator semiconductor laser

GaAs/GaAlAs heterostructure lasers with a monolithic confocal unstable resonator were demonstrated. The curved mirrors satisfying the confocal condition were fabricated by etching. Close to threshold, the lasers operate in a single lateral mode with a nearly collimated output beam. A single-lobe far-field intensity distribution as narrow as 1.9 degrees full width at half maximum was measured.

Frequency selectivity in laterally coupled semiconductor laser arrays

A longitudinal-mode analysis of a system of laterally coupled waveguided resonators is presented in the coupled-mode approximation. It is shown that variations in the mirror reflectivity of the individual channels result in coupling between the supermodes of the structure. This may lead to mode suppression by modulation of the threshold gain of different Fabry-Perot modes.