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Manning-Geist B, Meyer F, Chen J, Pelletier A, Kosman K, Chen X(P, Johnson NR. Pre-clinical Stress Management Workshops Increase Medical Students' Knowledge and Self-awareness of Coping with Stress. MEDICAL SCIENCE EDUCATOR 2020; 30:235-241. [PMID: 32435524 PMCID: PMC7223904 DOI: 10.1007/s40670-019-00881-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To investigate the effects of a stress management workshop on medical students' knowledge of stress and potential coping strategies. METHODS A panel discussion with small group breakouts on stress in clinical medicine, learning challenges, competition with colleagues, handling stressful events, and recognizing burnout symptoms was conducted with medical students entering clerkships. A longitudinal survey design was utilized to measure pre-, post-, and long-term (3-month) changes in knowledge (impact of stress on personal health, learning, and patient care), confidence, perceived skills, and attitude (towards utilizing adaptive coping strategies) among participating students (N = 135). Paired t test and multivariate analyses were performed to assess the differences between survey responses on a 5-point Likert scale. RESULTS Survey response rates were pre-90.4%, post-77%, and long-term post-71.1%. Compared to pre-workshop, students reported significant improvement in all four domains immediately post-workshop: knowledge (4.4 vs. 4.7, p < 0.05), confidence (3.6 vs. 3.9, p < 0.05), perceived skills (3.3 vs. 3.7, p < 0.05), and attitude (2.6 vs. 2.8, p < 0.05). Compared to immediate post-workshop, students' scores slightly decreased at 3 months but were overall significantly higher than the pre-workshop scores. CONCLUSIONS A stress management workshop can improve medical students' knowledge of the impact of stress as well as the use of adaptive stress coping strategies.
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Affiliation(s)
- Beryl Manning-Geist
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Fremonta Meyer
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Justin Chen
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Andrea Pelletier
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Katherine Kosman
- Department of Psychiatry, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA USA
| | - Xiaodong (Phoenix) Chen
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Natasha R. Johnson
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
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Professionalism for Physician Assistants. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Scudder DR, Sherry AD, Jarrett RT, Fernando S, Kuhn AW, Fleming AE. Fundamental Curriculum Change with 1-Year Pre-Clerkship Phase and Effect on Stress Associated with Residency Specialty Selection. MEDICAL SCIENCE EDUCATOR 2019; 29:1033-1042. [PMID: 34457581 PMCID: PMC8368347 DOI: 10.1007/s40670-019-00800-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Vanderbilt University School of Medicine recently changed from 2 pre-clerkship years (Traditional curriculum) to a 1.5-year pre-clerkship phase for one class (Hybrid curriculum) to a 1-year pre-clerkship phase (Curriculum 2.0). This study investigated the relationship between shortened pre-clerkship training and stress associated with selecting a residency field. The surveyed graduating medical student population included one cohort from the Traditional and Hybrid curricula, and the first two cohorts from Curriculum 2.0. The authors modeled recollected stress levels using a Zero-Inflated Linear Mixed Model with additional covariate and random effects adjustments. Specialty decision-related stress levels increased in the Hybrid curriculum by 10.208 points [p = 0.0115, 95% CI 2.293, 18.122] on a 0-100 point scale. Curriculum 2.0 students had an insignificant increase in stress of 4.062 points [p = 0.304, 95% CI - 3.690, 11.814] relative to the Traditional curriculum. Time since starting medical school and time when a specialty was chosen were the largest factors associated with stress. While this study only evaluated a single facet of the potential downstream effects of curricular change, these data should inspire confidence for reform efforts as a significant increase in specialty decision-related stress present in Hybrid curriculum resolved in both cohorts of Curriculum 2.0.
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Affiliation(s)
- David R. Scudder
- Vanderbilt University School of Medicine, Nashville, TN USA
- Departments of Internal Medicine and Pediatrics, University of Colorado School of Medicine, Aurora, CO USA
| | | | - Ryan T. Jarrett
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Shanik Fernando
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Andrew W. Kuhn
- Vanderbilt University School of Medicine, Nashville, TN USA
| | - Amy E. Fleming
- Vanderbilt University School of Medicine, Nashville, TN USA
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Wilkes C, Lewis T, Brager N, Bulloch A, MacMaster F, Paget M, Holm J, Farrell SM, Ventriglio A. Wellbeing and mental health amongst medical students in Canada. Int Rev Psychiatry 2019; 31:584-587. [PMID: 31638441 DOI: 10.1080/09540261.2019.1675927] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Across the world there is significant evidence that medical students have high levels of mental ill-health and psychological distress with subsequent concerning effects on personal and occupational functioning. In Canada, recent studies have demonstrated worrying levels of burnout and depressive symptoms among practising doctors. In common with other countries, Canadian medical students are also subject to a high-pressure environment - with long clinical weeks and significant stressors - and these soon-to-be doctors have been previously shown to already demonstrate high levels of burnout. We surveyed 69 medical students at the Cumming School of Medicine, Calgary regarding their wellbeing and mental health. 26% of the students had been diagnosed with a mental health condition prior to medical school, while 36% reported currently seeing a professional regarding their mental ill-health, with anxiety disorders forming the most commonly reported conditions. 83% reported their studies as a significant source of stress. 22% tested as CAGE positive and a number of students reported using other substances. 70% of medical students met specified case criteria for exhaustion on the Oldenburg Burnout Inventory. These findings speak to the need for access to mental health services, evidence-based individual counselling, and inclusive activities that fit within organisational frameworks to better improve the mental health and wellbeing of medical students in Canada.
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Affiliation(s)
- Chris Wilkes
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Thomas Lewis
- Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Nancy Brager
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrew Bulloch
- The Mathison Centre for Mental Health Research and Education, Calgary, Canada
| | - Frank MacMaster
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mike Paget
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Johanna Holm
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sarah Marie Farrell
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Chua IS, Bogetz AL, Bhansali P, Long M, Holbreich R, Kind T, Ottolini M, Park YS, Lineberry M, Hirshfield LE. The Patient Experience Debrief Interview: How Conversations With Hospitalized Families Influence Medical Student Learning and Reflection. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:S86-S94. [PMID: 31365398 DOI: 10.1097/acm.0000000000002914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To determine the effect of patient debrief interviews on pediatric clerkship student depth of reflection and learning. METHOD The authors conducted a multi-institutional, mixed-methods, cluster randomized trial among pediatric clerkship students from May 2016 to February 2017. Intervention students completed a debrief interview with a patient-caregiver, followed by a written reflection on the experience. Control students completed a written reflection on a memorable patient encounter. Three blinded authors scored written reflections according to the 4-level REFLECT rubric to determine depth of reflection. Interrater reliability was examined using kappa. REFLECT scores were analyzed using a chi-square test; essays were analyzed using content analysis. RESULTS Eighty percent of eligible students participated. One hundred eighty-nine essays (89 control, 100 intervention) were scored. Thirty-seven percent of the control group attained reflection and critical reflection, the 2 highest levels of reflection, compared with 71% of the intervention group; 2% of the control group attained critical reflection, the highest level, compared with 31% of the intervention group (χ(3, N = 189) = 33.9, P < .001). Seven themes were seen across both groups, 3 focused on physician practice and 4 focused on patients. Patient-centered themes were more common in the intervention group, whereas physician-focused themes were more common in the control group. CONCLUSIONS Patient debrief interviews offer a unique approach to deepen self-reflection through direct dialogue and exploration of patient-caregiver experiences during hospitalization.
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Affiliation(s)
- Ian S Chua
- I.S. Chua is assistant professor, Department of Pediatrics, Children's National Medical Center, Washington, DC, and clinical instructor, Department of Pediatrics, Stanford School of Medicine, Stanford, California. A.L. Bogetz is associate program director, Department of Pediatrics, Stanford School of Medicine, Stanford, California. P. Bhansali is associate professor, Department of Pediatrics, Children's National Medical Center, Washington, DC. M. Long is associate professor, Department of Pediatrics, University of California, San Francisco, San Francisco, California. R. Holbreich is a medical student, George Washington University School of Medicine and Health Sciences, Washington, DC. T. Kind is professor of pediatrics and associate dean of clinical education, George Washington University School of Medicine and Health Sciences, Washington, DC. M. Ottolini is vice chair of education and professor, Children's National Medical Center, Washington, DC. Y.S. Park is associate professor, Department of Medical Education, University of Illinois, Chicago, Chicago, Illinois. M. Lineberry is assistant professor and director of simulation research, assessment, and outcomes, University of Kansas City Medical Center, Kansas City, Kansas. L.E. Hirshfield is assistant professor, Department of Medical Education, University of Illinois, Chicago, Chicago, Illinois
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Farrell SM, Kar A, Valsraj K, Mukherjee S, Kunheri B, Molodynski A, George S. Wellbeing and burnout in medical students in India; a large scale survey. Int Rev Psychiatry 2019; 31:555-562. [PMID: 31774379 DOI: 10.1080/09540261.2019.1688047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medical students in India completed an anonymous online questionnaire regarding mental health and wellbeing, including Oldenburg burnout ratings, CAGE questionnaires, and general health questionnaire (GHQ12). Out of 597 student responses, over 80% were characterised as experiencing burnout. This study highlights the need to further examine this issue, including possible causes and solutions.
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Affiliation(s)
- Sarah Marie Farrell
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Anindya Kar
- Department of Psychiatry, Advanced Neuropsychiatry Institute, Kolkata, India
| | - Koravangattu Valsraj
- Department of Psychiatry, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Shuvankar Mukherjee
- Department of Community Medicine, Calcutta National Medical College, Kolkata, India
| | - Beena Kunheri
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, India
| | - Andrew Molodynski
- Department of Psychiatry, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, Oxford University, Oxford, UK
| | - Sanju George
- Rajagiri School of Behavioural Sciences and Research, Rajagiri College of Social Sciences (Autonomous), Kochi, India
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57
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Farrell SM, Moir F, Molodynski A, Bhugra D. Psychological wellbeing, burnout and substance use amongst medical students in New Zealand. Int Rev Psychiatry 2019; 31:630-636. [PMID: 31701792 DOI: 10.1080/09540261.2019.1681204] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medical students are thought to have increased pressures in study life beyond that of their peers. This could impact their psychological wellbeing, burnout and substance use, impeding a smooth transition into the health workforce. A cross-sectional electronic survey of one of New Zealand's two medical schools was undertaken, and students in all years were invited to participate through email. Two hundred and twenty students completed the survey. Forty-six students (21%) reported that they were currently seeing a GP or Allied Healthcare Professional (AHP) for their mental ill-health. Seventy-seven students (35%) reported having taken cannabis during medical school. The number of respondents reaching the threshold for CAGE, and thus demonstrating problem drinking, was 40 (18%). Additionally, burnout levels were scored, with 150 students (68%) classifying as disengaged and 169 (77%) as suffering from exhaustion on the Oldenburg burnout measure. Going forwards, organizational bodies including governments and medical schools should place emphasis on the importance of optimizing medical student wellbeing, including resilience training and improved workforce wellbeing planning, to positively impact not just medical students as they progress to doctors, but for patients, and the healthcare system as a whole.
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Affiliation(s)
- Sarah Marie Farrell
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Oxford University Clinical Academic Graduate School (OUCAGs), University of Oxford, Oxford, UK
| | - Fiona Moir
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrew Molodynski
- Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, Oxford University, Oxford, UK
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Michael K, Dror MG, Karnieli-Miller O. Students' patient-centered-care attitudes: The contribution of self-efficacy, communication, and empathy. PATIENT EDUCATION AND COUNSELING 2019; 102:2031-2037. [PMID: 31257098 DOI: 10.1016/j.pec.2019.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but research on perceptions and attitudes that contribute to PCC attitudes is limited. We tested a new model, assessing whether the association between self-efficacy and PCC attitudes is mediated by communication and empathy attitudes. Furthermore, we assessed medical-school-stage and gender differences in these variables. METHODS Medical/dentistry students (N = 653) completed self-reported questionnaires. Analyses were performed using Pearson's-correlations, PROCESS macro, and independent samples t-tests. RESULTS The association between communication self-efficacy and PCC attitudes was completely mediated by communication and empathy attitudes. Students in clinical years had more positive attitudes toward PCC and empathy, and higher communication self-efficacy. Females had more positive attitudes toward PCC, communication, and empathy. CONCLUSIONS The results emphasize the importance of communication self-efficacy and the mediating role of communication and empathy attitudes in enhancing PCC attitudes. This highlights the need to focus on learners' affective matter (what they feel/think) about their competencies and attitudes. PRACTICE IMPLICATIONS Educational interventions should improve understanding of the benefits of applying good communication skills, of learning the importance of empathy and its relevance to patient care, and strengthening students' confidence in applying these skills. Attention to these is important for enhancing students' PCC attitudes.
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Affiliation(s)
- Keren Michael
- Department of Human Services, The Max Stern Yezreel Valley Academic College, Yezreel Valley, Israel.
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Torales J, Kadhum M, Zárate G, Barrios I, González I, Farrell SM, Ventriglio A, Arce A. Wellbeing and mental health among medical students in Paraguay. Int Rev Psychiatry 2019; 31:598-602. [PMID: 31592689 DOI: 10.1080/09540261.2019.1667172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medical students' wellbeing and mental health are of extreme importance. Studies from around the world have shown that the rates of burnout appear to be high. It is also well recognized that individuals with mental illnesses frequently avoid seeking help for fear of stigma, affecting their careers and being rejected or treated differently by their peers, or due to the perception that they will be deemed unfit for practice or rejected from their preferred specialty. Students who are open about their mental health conditions are often ostracized by their own peers and dismissed or even mistreated by teachers who consider mental 'toughness' to be a requirement for success in the medical arena. The impact of socioeconomic conditions cannot be under-estimated. We carried out a survey of mental health and wellbeing of medical students in the National University of Asuncion. A sample of 180 students across different years showed that 21% had sought help and 4% had been diagnosed with a mental condition before entering medical school; 3% had been previously diagnosed with Attention Deficit Hyperactivity Disorder or Autism Spectrum Disorders; 14% currently consult with a health professional specifically about their mental health; and 8% reported currently taking medication for their mental health. The most common medication was Escitalopram at 21%, followed by Sertraline with 11%. Various sources of stress were identified, all of which were noted to be concerning four specific domains: financial difficulties, familial issues, housing issues, and difficulties surrounding studies. Of these students, 20% were CAGE positive and 9.4% reported using substances to feel better. These findings indicate that medical students need better support to ensure that they function better. They require in-depth exploration of the potential causes of their illnesses.
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Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Murtaza Kadhum
- Oxford University Clinical Academic, Graduate School, University of Oxford, Oxford, UK
| | - Gabriel Zárate
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Israel González
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Sarah Marie Farrell
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrés Arce
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
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Chau SWH, Lewis T, Ng R, Chen JY, Farrell SM, Molodynski A, Bhugra D. Wellbeing and mental health amongst medical students from Hong Kong. Int Rev Psychiatry 2019; 31:626-629. [PMID: 31687856 DOI: 10.1080/09540261.2019.1679976] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medical students are a known high-risk group for mental health issues. This study aimed to survey the psychological well-being of medical students from Hong Kong, a known stressful city. This study is part of a wider effort to compare the psychological well-being of medical students world-wide. We invited medical students from Hong Kong to complete a self-report questionnaire online. The questionnaire included questions on demographics, known mental health issues, sources of psychological stress, and substance use. It also included the cut-annoyed-guilty-eye (CAGE) questionnaire, Short-Form General Health Questionnaire (GHQ-12), and the Oldenburg Burnout Inventory (OLBI). There were 123 responses. Our results suggest high levels of psychological morbidity and distress among medical students in Hong Kong. 87% screened positive for minor psychiatric disorders on the GHQ-12 and 95% met OLBI thresholds for burnout. Female respondents demonstrated significantly higher mean GHQ-12 scores than male. Despite the apparent high prevalence of mental ill-health in this population, only 15% of respondents reported receiving professional help.
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Affiliation(s)
- Steven W H Chau
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, HKSAR
| | - Thomas Lewis
- General Adult Psychiatry, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Roger Ng
- Hong Kong College of Psychiatrists, Hong Kong, HKSAR.,Department of Psychiatry, Hong Kong University and Chinese University of Hong Kong, Hong Kong, HKSAR
| | | | - Sarah Marie Farrell
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Oxford University Clinical Academic Graduate School (OUCAGs), University of Oxford, Oxford, UK
| | - Andrew Molodynski
- General Adult Psychiatry, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Dinesh Bhugra
- Institute of Psychiatry, King's College London, London, UK
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Esan O, Esan A, Folasire A, Oluwajulugbe P. Mental health and wellbeing of medical students in Nigeria: a systematic review. Int Rev Psychiatry 2019; 31:661-672. [PMID: 31646912 DOI: 10.1080/09540261.2019.1677220] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
In addition to the stresses common to medical school training, medical students in Nigeria face additional peculiar contemporary social problems due to income inequality, poverty, insecurity and political instability. These have a direct impact on their mental health and wellbeing. The aim of this study was to systematically review articles reporting on the epidemiology of psychiatric disorders among medical students in Nigeria. Studies were identified using MEDLINE, HINARI, African Journal Online (AJOL) and Google Scholar databases using search terms encompassing psychiatric morbidity amongst medical students. No date restrictions were applied to the search. The pooled prevalence estimate was calculated for each disorder. Psychological distress was present in 25.2% of the students, perceived stress in 60.5%, depression in 33.5% and anxiety in 28.8%. The current use of at least one psychoactive substance was present in up to 44.2%, while 35.5% of all the respondents had experienced one or more forms of abuse during their training as medical students. The prevalence of psychiatric disorders among medical students in Nigeria is high. Positive coping mechanisms such as religiosity, positive reframing and resilience which were identified in this review should be optimized to reduce the burden.
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Affiliation(s)
- Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Arinola Esan
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ayorinde Folasire
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
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Masri R, Kadhum M, Farrell SM, Khamees A, Al-Taiar H, Molodynski A. Wellbeing and mental health amongst medical students in Jordan: a descriptive study. Int Rev Psychiatry 2019; 31:619-625. [PMID: 31578112 DOI: 10.1080/09540261.2019.1670402] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Across the globe medical students are experiencing high levels of depression, anxiety, and psychological distress. This can ultimately lead to poor academic performance, substance misuse and/or concerns over clinical practice and fitness to practice. We surveyed Jordanian medical students to assess burnout (using the Oldenburg Burnout Inventory, OLBI), minor psychiatric illness (General Health Questionnaire 12, GHQ12) and alcohol/substance abuse (CAGE questionnaire). Results indicate a high level of exhaustion (91%), disengagement (87%) and 'minor' psychiatric illness (92%). OLBI and GHQ12 scores were found to correlate positively (p < 0.001). The CAGE questionnaire was positive in 8% of students. Further research is required to confirm these results and compare them to the global burden of mental illness in medical students. Medical students in Jordan should be considered a high-risk group for burnout and mental health problems and strategies should be employed to recognise and appropriately manage those most at risk.
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Affiliation(s)
| | - Murtaza Kadhum
- Oxford University Clinical Academic Graduate School (OUCAGs), University of Oxford, Oxford, UK
| | - Sarah Marie Farrell
- Oxford University Clinical Academic Graduate School (OUCAGs), University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | | | - Andrew Molodynski
- Oxford Health NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
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Hammerich K, Stuber K, Hogg-Johnson S, Abbas A, Harris M, Lauridsen HH, Lemeunier N, Maiers M, McCarthy P, Morales V, Myburgh C, Petrini V, Pohlman K, Mior S. Assessing attitudes of patient-centred care among students in international chiropractic educational programs: a cross-sectional survey. Chiropr Man Therap 2019; 27:46. [PMID: 31528334 PMCID: PMC6739992 DOI: 10.1186/s12998-019-0263-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Patient-centred care is internationally recognized as a foundation of quality patient care. Attitudes of students towards patient-centred care have been assessed in various health professions. However, little is known how chiropractic students’ attitudes towards patient-centred care compare to those of other health professions or whether they vary internationally, and between academic programs. Objective To assess the association of select variables on student attitude towards patient-centred care among select chiropractic programs worldwide. Methods We conducted a cross-sectional study using the Patient-Practitioner Orientation Scale (PPOS) to assess students’ patient-centred attitudes towards the doctor-patient relationship. Eighteen items were scored on a 1 to 6 Likert scale; higher scores indicating more patient-centredness. All students from seven chiropractic educational programs worldwide were invited to complete an online survey. Results were analyzed descriptively and inferentially for overall, sharing and caring subscales. General linear regression models were used to assess the association of various factors with PPOS scores. Results There were 1858 respondents (48.9% response rate). Student average age was 24.7 (range = 17–58) years and 56.2% were female. The average overall PPOS score was 4.18 (SD = 0.48) and average sharing and caring subscale scores were 3.89 (SD = 0.64) and 4.48 (SD = 0.52), respectively. There were small but significant differences in all PPOS scores by gender, age, and program. Year/semester of study within a program typically was not associated with scores, neither was history of previous chiropractic care nor having family members who are health professionals. Conclusion This is the first international study assessing students’ attitudes of patient-centred care in chiropractic educational programs. We found small but significantly different PPOS scores between chiropractic programs worldwide that did not change across year/semester of study. Scores tended to be lower than those reported among medical students. Observed differences may be related to curricular content, extent of patient exposure and/or regional cultural realities.
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Affiliation(s)
- Karin Hammerich
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Kent Stuber
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Sheilah Hogg-Johnson
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Anser Abbas
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Martin Harris
- 2Central Queensland University, Rockhampton, Australia
| | | | | | - Michele Maiers
- 5Northwestern Health Sciences University, Bloomington, USA
| | | | | | | | - Vanessa Petrini
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | | | - Silvano Mior
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
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Kwankajonwong N, Ongprakobkul C, Qureshi SP, Watanatada P, Thanprasertsuk S, Bongsebandhu-Phubhakdi S. Attitude, but not self-evaluated knowledge, correlates with academic performance in physiology in Thai medical students. ADVANCES IN PHYSIOLOGY EDUCATION 2019; 43:324-331. [PMID: 31305154 DOI: 10.1152/advan.00047.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Positive attitude and self-evaluation are necessary for medical students and doctors. To explore how best to integrate physiology teaching in our Thai medical curriculum, we investigated relationships between student's academic performance, their attitude, self-evaluated knowledge, and proportion of physiology taught in an organ-system integrated block. We organized 13 physiology laboratory classes, during which students self-rated attitude and knowledge. Academic performance was measured by formative and summative assessments. One hundred thirty-six participants were categorized into most proactive (Most PA), more proactive (More PA), less proactive (Less PA), and least proactive (Least PA) attitude groups by self-preparation questionnaire. Eighty participants were categorized into high (HighE), moderate (ModerateE), and low (LowE) self-evaluation rating groups. Mean formatives score in the Most PA group was significantly higher than in the other PA groups (P = 0.003, P = 0.001, and P < 0.001, respectively). Mean summative score in the Most PA group was significantly higher than the Less PA and the Least PA groups (P = 0.017 and P = 0.015 respectively). There was no significant difference in mean assessment scores among HighE, ModerateE, and LowE groups. Proportion of teaching time dedicated to physiology positively correlated with student attitude (r = 0.84, P = 0.001) and negatively correlated with self-evaluation rating (r = -0.73, P = 0.007). Thai medical students may benefit from a proactive attitude to studying physiology, contrasting with traditional didactic expectations of Thai education. Proportion of teaching time dedicated to physiology does not influence academic performance; therefore, future adjustments to curriculum integration may incorporate classes that facilitate self-directed learning. Future study should explore other influences on learning and assessment performance.
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Affiliation(s)
| | - Chuthamas Ongprakobkul
- Department of Physiology, Faculty of Medicine, Chulalongkorn University , Bangkok , Thailand
| | - Shaun Peter Qureshi
- Edinburgh Medical School, University of Edinburgh , Edinburgh , United Kingdom
| | - Pasakorn Watanatada
- Department of Physiology, Faculty of Medicine, Chulalongkorn University , Bangkok , Thailand
| | - Sekh Thanprasertsuk
- Department of Physiology, Faculty of Medicine, Chulalongkorn University , Bangkok , Thailand
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Duford A, Matvienko O. Student-Led Mobile Health Clinic: Patients Served and Learning Experience. J Physician Assist Educ 2019; 30:149-154. [PMID: 31385911 DOI: 10.1097/jpa.0000000000000266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Community medicine curriculum prepares physician assistant (PA) students to provide services to vulnerable and underserved populations. This article describes a service-learning model that uses a mobile health clinic (MHC) experience as part of the community medicine rotation. It provides an overview of the clinic's operation, patient documentation and characteristics, and student learning experiences. METHODS Students collected demographic information on patients who visited the MHC during January through December 2017. The students summarized patient demographics and reflected on their experiences in a report. RESULTS Two main outcomes are discussed: characteristics of the MHC patients and student observations about their experiences. In 2017, 113 students rotated through the MHC and recorded 813 patient encounters. The largest proportions of patients reported living on the street or in a shelter (71%) and were older than 56 years (40%), males (74%), Caucasian (43%), single (65%), nonveterans (77%), and high school graduates (41%). The top 5 reasons for visits were preventive care, cognitive/functional impairment, cardiometabolic disorders, skin issues, and respiratory illness. The MHC experience and process of recording and analyzing demographic data contributed to students' data management and analytical skills. The students identified problems of recordkeeping and their implications for patient care, gained a greater understanding of medical needs and complexities of treating the homeless, and provided suggestions for improving quality and efficiency of care. CONCLUSIONS The MHC service-learning model provides diverse, meaningful experiences for students. Our findings benefit PA programs aiming to expand and strengthen their community medicine curriculum.
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Affiliation(s)
- Amie Duford
- Amie Duford, MPAS, PA-C, is an assistant professor in the School of Physician Assistant Studies at Touro University Nevada, Henderson, Nevada. Oksana Matvienko, PhD, is an associate professor in the School of Physician Assistant Studies at Touro University Nevada, Henderson, Nevada
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Johnson NR, Pelletier A, Chen X, Manning-Geist BL. Learning in a High-Stress Clinical Environment: Stressors Associated with Medical Students' Clerkship Training on Labor and Delivery. TEACHING AND LEARNING IN MEDICINE 2019; 31:385-392. [PMID: 30907690 DOI: 10.1080/10401334.2019.1575742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Obstetrics and gynecology can be a high-stress clinical environment for medical students due to the specialty's fast-paced and unpredictable nature. Little is known about learning stressors for medical students on the obstetrics and gynecology clerkship to inform stress-reducing interventions and improve learning experience. This study investigated (a) which aspects of the learning environment are most stressful for obstetrics and gynecology clerkship students, (b) how perceived learning stressors in this environment differ for medical students and teachers (residents, fellows, and faculty), and (c) what interventions students propose to address these stressors. Approach: From May 2015 to April 2016, we conducted semistructured individual interviews with 3rd-year medical students from obstetrics and gynecology clerkship cohorts (n = 52) as well as clerkship teachers (n = 10) at an academic medical center. Two investigators used a qualitative Framework Method approach to analyze the interview data and agree upon final themes. Findings: We identified labor and delivery as the most stressful learning environment and four labor and delivery-related themes of students' learning stressors: context (pace, logistics, nature of childbirth, and nonroutine schedule), learning tasks (student role and assignments and the amount of new knowledge and skills), communication (terminology used in conversation and interacting with the labor and delivery team), and clinical scenario (crisis, emergency, and patient refusal of student involvement). Whereas students identified context as causing most of the stress, teachers concentrated on stressors related to learning tasks. Insights: Learning stressors associated with students' educational experience in the clinical context of labor and delivery are challenging for medical students. In addition to the specific content of these challenges, the recognition that teachers' assumptions about sources of stressors are different from those of students is an important finding and has implications for changing the learning environment. Clerkship programs are encouraged to provide practical guidelines and embed an introduction of the clinical learning environment into the Obstetrics and Gynecology clerkship orientation curriculum.
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Affiliation(s)
- Natasha R Johnson
- a Department of Obstetrics and Gynecology , Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Andrea Pelletier
- a Department of Obstetrics and Gynecology , Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Xiaodong Chen
- a Department of Obstetrics and Gynecology , Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Beryl L Manning-Geist
- a Department of Obstetrics and Gynecology , Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
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Vogel D, Seeliger H, Harendza S. Longitudinal development of different dimensions of perfectionism in undergraduate medical students with respect to their medical school admission procedure. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc44. [PMID: 31544144 PMCID: PMC6737256 DOI: 10.3205/zma001252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/11/2019] [Accepted: 07/01/2019] [Indexed: 05/28/2023]
Abstract
Objective: The concept of perfectionism comprises high standards of performance as needed in medicine, but also concerns about making mistakes and dealing with social reactions about not being perfect. Perfectionism is associated with motivation and deep learning strategies but high expression of perfectionism has been found to be associated with symptoms of stress and anxiety in students. We aim to gain insights into the longitudinal development of different dimensions of perfectionism in medical students with respect to their way of medical school admission. Methods: At the Medical Faculty of Hamburg University, 167 undergraduate medical students completed validated questionnaires (MPS-H and MPS-F) of different dimensions of perfectionism and sociodemographic data including medical school admission procedures, personality traits (BSI-10 and GSE), and symptoms of depression and anxiety (PHQ-9 and GAD-7) at the start of their first year and at half term of their second year. Results: On average, after controlling for baseline and age, a significant decrease (p≤0.05) in Self-Oriented Perfectionism was found during the first two years in students who were admitted after a waiting period (M: -12.57; 95% CI: [-21.94 - -3.35]), by other ways of medical school entrance (M: -6.36; 95% CI: [-12.71 - -0.02]), by multiple mini-interviews (HAM-Int) (M: -5.52; 95% CI: [-9.90 - -1.14]), and by a natural science test (HAM-Nat) (M: -3.41; 95% CI: [-6.71 - -0.11]. Waiting period students also showed a significant longitudinal decline in the scale Personal Standards (M: -4.62; 95% CI: [-8.04 - -1.21]. Conclusions: Since medical students from all admission groups except from the high school degree group showed a significant longitudinal decrease in Self-Oriented Perfectionism, high levels of aspects of perfectionism associated with intrinsic motivation or deep learning strategies could be included medical school admission processes. Additionally, particular attention needs to be paid not to induce a loss of intrinsic motivation or deep learning strategies during undergraduate medical education.
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Affiliation(s)
- Daniela Vogel
- University Medical Center Hamburg-Eppendorf, III. Department of Internal Medicine, Hamburg, Germany
| | - Helen Seeliger
- University Medical Center Hamburg-Eppendorf, III. Department of Internal Medicine, Hamburg, Germany
| | - Sigrid Harendza
- University Medical Center Hamburg-Eppendorf, III. Department of Internal Medicine, Hamburg, Germany
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von Widekind S, Machin M. Response to "Medical students' attitudes toward communication skills learning: comparison between two groups with and without training" [Letter]. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:305-306. [PMID: 31191079 PMCID: PMC6535435 DOI: 10.2147/amep.s207528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/04/2019] [Indexed: 06/01/2023]
Affiliation(s)
| | - Matthew Machin
- Department of Surgery and Cancer, Imperial College London, London, UK
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Panczyk M, Iwanow L, Zarzeka A, Jaworski M, Gotlib J. Communication skills attitude scale: a translation and validation study in asample of registered nurses in Poland. BMJ Open 2019; 9:e028691. [PMID: 31072864 PMCID: PMC6527998 DOI: 10.1136/bmjopen-2018-028691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To translate and validate the Communication Skills Attitude Scale in the Polish language (CSAS-P) and its adaptation for use among registered nurses. DESIGN A cross-sectional descriptive design was used in order to translate and validate the CSAS-P. The following psychometric properties of CSAS-P were evaluated: content validity (content validity index), theoretical relevance (exploratory and confirmative factor analysis), one-dimensionality of subscales (principal component analysis), internal consistency (Cronbach's α), test-retest reliability and discriminant validity. SETTING Participants were identified and recruited from the Centre for Postgraduate Education for Nurses and Midwives in Warsaw, Poland. PARTICIPANTS The validation group comprised 2014 registered nurses who were undertaking a spring specialisation exam in 2017. RESULTS The overall content validity index was >0.80, which was interpreted as indicating validity. The factor structure of CSAS-P differed from the original version, and removing three items from the scale better fit the data. The positive attitude subscale (11 items) and negative attitude subscale (12 items) were characterised by one-dimensionality and high internal consistency (Cronbach's α=0.901 and 0.802, respectively). Test-retest analysis confirmed the stability of the measurement for both subscales and particular items. Nurses with prior participation in communication courses scored significantly higher than those without such education (p<0.05), confirming the discriminant validity of CSAS-P. CONCLUSIONS The psychometric properties of CSAS-P were comparable to the English language original. Further validation of CSAS-P in other groups of healthcare professionals may increase its applicability. CSAS-P can be used to evaluate attitudes towards learning communication skills among registered nurses.
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Affiliation(s)
| | - Lucyna Iwanow
- Department of Education and Research in Health Sciences , Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Aleksander Zarzeka
- Department of Education and Research in Health Sciences , Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Jaworski
- Department of Education and Research in Health Sciences , Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Gotlib
- Department of Education and Research in Health Sciences , Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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Harendza S, Soll H, Prediger S, Kadmon M, Berberat PO, Oubaid V. Assessing core competences of medical students with a test for flight school applicants. BMC MEDICAL EDUCATION 2019; 19:9. [PMID: 30616684 PMCID: PMC6322305 DOI: 10.1186/s12909-018-1438-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 12/26/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Important competences of physicians regarding patient safety include communication, leadership, stress resistance, adherence to procedures, awareness, and teamwork. Similarly, while selected, prospective flight school applicants are tested for the same set of skills. The aim of our study was to assess these core competences in advanced undergraduate medical students from different medical schools. METHODS In 2017, 67 medical students (year 5 and 6) from the universities of Hamburg, Oldenburg, and TU Munich, Germany, participated in the verified Group Assessment Performance (GAP)-Test at the German Aerospace Center (DLR) in Hamburg. All participants were rated by DLR assessment observers with a set of empirically derived behavioural checklists. This lists consisted of 6-point rating scales (1: very low occurrence to 6: very high occurrence) and included the competences leadership, teamwork, stress resistance, communication, awareness, and adherence to procedures. Medical students' scores were compared with the results of 117 admitted flight school applicants. RESULTS Medical students showed significantly higher scores than admitted flight school applicants for adherence to procedures (p < .001, d = .63) and communication (p < .01, d = .62). They reached significantly lower ratings for teamwork (p < .001, d = .77), stress resistance (p < 0.001, d = .70), and awareness (p < .001, d = 1.31). Students in semester 10 showed significantly (p < .02, d = .58) higher scores in domain awareness compared to the final year students. On average, flight school entrance level was not reached by either group for this domain. CONCLUSIONS Advanced medical students' low results for awareness are alarming as awareness is essential and integrative for clinical reasoning and patient safety. Further studies should elucidate and discuss whether awareness needs to be included in medical student selection or integrated into the curriculum in training units.
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Affiliation(s)
- Sigrid Harendza
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | | | - Sarah Prediger
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Kadmon
- Medical Faculty, Deanery, University of Augsburg, Augsburg, Germany
| | - Pascal O. Berberat
- TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany
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Yeung S, Bombay A, Walker C, Denis J, Martin D, Sylvestre P, Castleden H. Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study. BMC MEDICAL EDUCATION 2018; 18:307. [PMID: 30547790 PMCID: PMC6295008 DOI: 10.1186/s12909-018-1401-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Including content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students' beliefs and behaviours. METHODS A total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students' sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students' perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses. RESULTS Generally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community. CONCLUSIONS Students' positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students' future behaviours and ultimately improve physician relationships with Indigenous patients.
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Affiliation(s)
- Sharon Yeung
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario Canada
- School of Medicine, Queen’s University, Kingston, Ontario Canada
| | - Amy Bombay
- Department of Psychiatry and School of Nursing, Dalhousie University, Halifax, Nova Scotia Canada
| | - Chad Walker
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
| | - Jeff Denis
- Department of Sociology, McMaster University, Hamilton, Ontario Canada
| | - Debbie Martin
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia Canada
| | - Paul Sylvestre
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
| | - Heather Castleden
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario Canada
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
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Chen JA, Rosenberg LB, Schulman BJ, Alpert JE, Waldinger RJ. Reexamining the Call of Duty: Teaching Boundaries in Medical School. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1624-1630. [PMID: 29847327 DOI: 10.1097/acm.0000000000002305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although healthy physician-patient boundaries are essential to medical practice, published research on how to teach this important topic to medical students is lacking. Physician-patient boundaries, the interpersonal limits placed on behavior within a clinical relationship, protect providers and patients alike, and they represent a key component of professionalism. However, these boundaries may be difficult to teach and frequently are not presented as part of the formal curriculum, except in communication-focused specialties such as psychiatry and palliative care. Medical students may be particularly susceptible to boundary concerns due to the inherent ambiguities of their role within the medical team. In this Perspective, the authors present the adapted, anonymized case of a medical student who encountered a boundary issue during a clinical rotation. Following a brief review of the limited published literature regarding the teaching of boundaries during medical school, the authors define key concepts, including the clinical frame, boundary crossings and violations, fiduciary duty, and dual relationships. Next, they provide examples of common boundary challenges that arise during the course of undergraduate medical education and later during clinical practice. The authors present factors that may contribute to boundary concerns, including characteristics of providers and patients, and they describe some of the potential consequences of boundary violations. They propose a curriculum for teaching medical students about boundaries, providing concrete suggestions for how to do so at both the preclinical and clinical levels. Before closing, they apply insights from the Perspective to the example case.
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Affiliation(s)
- Justin A Chen
- J.A. Chen is associate director of medical student education in psychiatry and assistant professor of psychiatry, Harvard Medical School, and medical director of ambulatory psychiatry services, Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-1504-0094. L.B. Rosenberg is instructor in medicine, Harvard Medical School, and physician, Massachusetts General Hospital Division of Palliative Care, Boston, Massachusetts. B.J. Schulman is instructor in psychiatry, Harvard Medical School, and assistant director, Center for Psychodynamic Therapy, Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts. J.E. Alpert is professor of psychiatry, neuroscience, and pediatrics, and Silverman University Chair, Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York. R.J. Waldinger is clinical professor of psychiatry, Harvard Medical School, Boston, Massachusetts
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Brouwers MH, Bor H, Laan R, van Weel C, van Weel-Baumgarten E. Students' experiences with a longitudinal skills training program on breaking bad news: A follow-up study. PATIENT EDUCATION AND COUNSELING 2018; 101:1639-1644. [PMID: 29779606 DOI: 10.1016/j.pec.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/15/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) should be trained, preferably early and following a helical model with multiple sessions over time, including feedback on performance. It's unclear how medical students evaluate such an approach. METHODS We gathered student opinions regarding a helical BBN training programme, the feedback and emotional support they received, and the applicability of the skills training immediately after BBN skills training (Q1) and after finishing their clinical clerkships (Q2). RESULTS Students find a helical curriculum useful, but this declines on follow-up. At Q2 students report less satisfaction with the amount of feedback and emotional support they received and report that the skills training was less applicable in clinical practice compared to what they reported at Q1. CONCLUSION A helical BBN training programme with early exposure seems to lead to a shift from students being unconsciously incompetent to consciously incompetent. Students would have appreciated more emotional support and feedback. PRACTICE IMPLICATIONS We recommend more feedback and emotional support after BBN during clerkships. The gap between classroom and practice can be diminished by emphasizing real life role play and clinical role models should demonstrate continuity and agreement between the skills that are taught and those that are used in clinical practice.
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Affiliation(s)
- M H Brouwers
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - H Bor
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - R Laan
- Health Academy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - C van Weel
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia.
| | - E van Weel-Baumgarten
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Familiarity and Interest in Working with Livestock Decreases the Odds of Having Positive Attitudes towards Non-Human Animals and Their Welfare among Veterinary Students in Italy. Animals (Basel) 2018; 8:ani8090150. [PMID: 30135350 PMCID: PMC6162740 DOI: 10.3390/ani8090150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Veterinary students are the future generation of veterinary practitioners. Therefore, their attitudes towards non-human animals and animal welfare have a substantial impact on animal welfare itself. This study investigated the attitudes of veterinary students in Italy. The findings suggest that factors such as female gender, familiarity with pets, or the intention to work with pet species, as well as an animal-free diet, and membership in an animal rights association are the predictors of a very positive attitude towards animals and their welfare. Familiarity and intention to work with livestock is instead associated with a less positive attitude. Students also considered the freedom to express normal behaviours and the freedom from fear and distress to be less important for livestock than for pets. Veterinary curricula should take these findings into account to improve the attitudes of students in order to improve animal welfare, especially the welfare of livestock. Abstract We investigated the attitudes of veterinary students towards animals and their welfare in Italy. Regression analyses revealed predictors that are significant in differentiating students’ scoring tendency based on their gender, familiarity, and intention to work with a specific animal species, type of diet, and membership in an animal rights association. Female students, who were mostly familiar with pets and aspired to work with species other than livestock, following an animal-free diet and being a member of an animal rights association, had a significantly greater odds of having a high Animal Attitude Scale score (AAS), i.e., very positive attitude towards animals, versus a less positive attitude. Conversely, the familiarity with livestock and preference for working with livestock significantly increased the odds of a low AAS. Overall, students considered all of the Brambell Report’s Five Freedoms important for animal welfare protection. However, students scored higher for companion animals than for livestock, particularly regarding the freedom to express normal behaviour and the absence of fear and distress. This study suggests that veterinary students place less importance on the psychological aspects of welfare for livestock, and there is a tendency for students who are mostly familiar, or aspire to work, with livestock to have a less positive attitude towards non-human animals and their welfare. These findings should be considered within the veterinary educational curriculum due to their potential impact on animal welfare.
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Rice K, Ryu JE, Whitehead C, Katz J, Webster F. Medical Trainees' Experiences of Treating People With Chronic Pain: A Lost Opportunity for Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:775-780. [PMID: 29140917 PMCID: PMC5929494 DOI: 10.1097/acm.0000000000002053] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Evidence suggests that physicians' opinions about patients with chronic pain become progressively negative over the course of medical training, leading to decline in empathy for these patients. Few qualitative studies have focused on this issue, and thus the experiences shaping this process remain unexplored. This study addressed how medical trainees learn about chronic pain management through informal and formal curricula. METHOD This study adopted a constructive qualitative approach informed by the theoretical lens of the hidden curriculum. Thirteen open-ended interviews were conducted with medical students and residents at various training stages; interviewees had experience treating patients with chronic pain, shadowing the care of these patients, or both. Interviews elicited information about stage of medical training, general descriptions of work, and concrete experiences of managing patients with chronic pain. All interviews were collected in Toronto between June and August 2015. RESULTS Most interviewees described the management of chronic pain as challenging and unrewarding and attributed this at least in part to their perception that pain was subjective. Trainees also recounted that their inability to cure chronic pain left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value. CONCLUSIONS Specifically because chronic pain is subjective and incurable, listening and communication become crucial for patient care. Instead of sheltering trainees, medical educators should be offered the opportunity to reflect on the skills that are required to provide patient-centered care for this population. This approach has the potential to greatly benefit both trainees and patients.
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Affiliation(s)
- Kathleen Rice
- K. Rice is a postdoctoral fellow, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jae Eun Ryu
- J.E. Ryu is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- C. Whitehead is director and scientist, Wilson Centre, University Health Network, associate professor, Department of Family and Community Medicine, University of Toronto, vice president for education, Women’s College Hospital, and BMO Financial Group Chair, Health Professions Research, University Health Network, Toronto, Ontario, Canada
| | - Joel Katz
- J. Katz is professor and Canada Research Chair in Health Psychology, Department of Psychology, York University, Toronto, Ontario, Canada
| | - Fiona Webster
- F. Webster is associate professor, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, scientist, Wilson Centre, University Health Network, and academic fellow, Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
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Yang E, Schamber E, Meyer RML, Gold JI. Happier Healers: Randomized Controlled Trial of Mobile Mindfulness for Stress Management. J Altern Complement Med 2018; 24:505-513. [PMID: 29420050 DOI: 10.1089/acm.2015.0301] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Medical students have higher rates of depression and psychologic distress than the general population, which may negatively impact academic performance and professional conduct. This study assessed whether 10-20 min of daily mindfulness meditation for 30 days, using a mobile phone application, could decrease perceived stress and improve well-being for medical students. METHODS Eighty-eight medical students were stratified by class year and randomized to either intervention or control groups to use the mobile application Headspace, an audio-guided mindfulness meditation program, for 30 days. All participants completed the Perceived Stress Scale (PSS), Five-Facet Mindfulness Questionnaire (FFMQ), and General Well-Being Schedule (GWBS) at baseline (T1), 30 days (T2), and 60 days (T3). Repeated measures analysis of variance (rANOVA) was conducted for intervention versus control groups across T1, T2, and T3 to examine differences in stress, mindfulness, and well-being. RESULTS There was a significant interaction between time and treatment group for perceived stress and well-being. Perceived stress significantly decreased for the intervention group from T1 to T3 (F[2,142] = 3.98, p < 0.05). General well-being significantly increased for the intervention group compared to the control group from T1 to T2, and the increase was sustained through T3 (F[2,144] = 3.36, p < 0.05). CONCLUSIONS These results highlight that a mobile audio-guided mindfulness meditation program is an effective means to decrease perceived stress in medical students, which may have implications on patient care. Integrating mindfulness training into medical school curricula for management of school- and work-related stress may lead to fewer negative physician outcomes (e.g., burnout, anxiety, and depression) and improved physician and patient outcomes. This has implications for a broad group of therapists and healthcare providers, ultimately improving quality of healing and patient care.
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Affiliation(s)
- Elaine Yang
- 1 Department of Emergency Medicine, Highland Hospital-Alameda Health System , Oakland, CA
| | | | - Rika M L Meyer
- 3 Psychology Department, Bellevue College , Bellevue, WA
| | - Jeffrey I Gold
- 4 Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles , Los Angeles, CA.,5 Department of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California , Los Angeles, CA
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Ishikawa H, Son D, Eto M, Kitamura K, Kiuchi T. Changes in patient-centered attitude and confidence in communicating with patients: a longitudinal study of resident physicians. BMC MEDICAL EDUCATION 2018; 18:20. [PMID: 29370796 PMCID: PMC5785873 DOI: 10.1186/s12909-018-1129-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/17/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Patient-centered care has been one of the most frequently discussed principles in medical practice. However, there is a serious concern that the patient-centered attitudes of physicians diminish over the course of their medical education. This longitudinal study examined changes in resident physicians' patient-centered attitudes and their confidence in communicating with patients, and explored the relationship between the two traits. METHODS The study participants were resident physicians at a university hospital in Tokyo. Participants' patient-centered attitudes (as measured by the Patient-Practitioner Orientation Scale [PPOS]), and their confidence in communicating with patients (as per the Physician Confidence in the Medical Interview scale: [PCMI]) were assessed through self-reported questionnaires completed at the beginning of residency (n = 204) and again at the end of the first year (n = 95). RESULTS PPOS scores declined significantly during the year, both in terms of attitude toward sharing information and decision-making with patients, and attitude of caring for patients' expectations and emotions. The shift in caring attitude differed significantly by gender. The increase in PCMI score was greater for those with a smaller decrease in PPOS score. CONCLUSIONS As seen in previous studies of medical students, resident physicians' patient-centered attitudes declined during their first year of residency, while there may be a gender-based difference within the shift. The increase in physicians' confidence in communicating with patients was greater for those who showed a smaller decline in patient-centered attitude. Additional studies are needed to detail the changes in physicians' attitudes, confidence, and communication skills over the course of their medical training, and to develop systematic assessment and training programs.
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Affiliation(s)
- Hirono Ishikawa
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Daisuke Son
- International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Masato Eto
- International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
- General Education Center, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Kiyoshi Kitamura
- School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita-shi, Chiba, 286-8686 Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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Dominicé Dao M, Inglin S, Vilpert S, Hudelson P. The relevance of clinical ethnography: reflections on 10 years of a cultural consultation service. BMC Health Serv Res 2018; 18:19. [PMID: 29325569 PMCID: PMC5765648 DOI: 10.1186/s12913-017-2823-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/28/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Training health professionals in culturally sensitive medical interviewing has been widely promoted as a strategy for improving intercultural communication and for helping clinicians to consider patients' social and cultural contexts and improve patient outcomes. Clinical ethnography encourages clinicians to explore the patient's explanatory model of illness, recourse to traditional and alternative healing practices, healthcare expectations and social context, and to use this information to negotiate a mutually acceptable treatment plan. However, while clinical ethnographic interviewing skills can be successfully taught and learned, the "real-world" context of medical practice may impose barriers to such patient-centered interviewing. Creating opportunities for role modeling and critical reflection may help overcome some of these barriers, and contribute to improved intercultural communication in healthcare. We report and reflect on a retrospective analysis of 10 years experience with a "cultural consultation service" (CCS) whose aim is to provide direct support to clinicians who encounter intercultural difficulties and to model the usefulness of clinical ethnographic interviewing for patient care. METHODS We analyzed 236 cultural consultation requests in order to identify key patient, provider and consultation characteristics, as well as the cross cultural communication challenges that motivate health care professionals to request a cultural consultation. In addition, we interviewed 51 clinicians about their experience and satisfaction with the CCS. RESULTS Requests for cultural consultations tended to involve patient care situations with complex social, cultural and medical issues. All patients had a migration background, two-thirds spoke French less than fluently. In over half the cases, patients had a high degree of social vulnerability, compromising illness management. Effective communication was hindered by language barriers and undetected or underestimated patient/provider differences in health-related knowledge and beliefs. Clinicians were highly satisfied with the CCS, and appreciated both the opportunity to observe how clinical ethnographic interviewing is done and the increased knowledge they gained of their patients' context and perspective. CONCLUSIONS A cultural consultation service such as ours can contribute to institutional cultural competence by drawing attention to the challenges of caring for diverse patient populations, identifying the training needs of clinicians and gaps in resource provision, and providing hands-on experience with clinical ethnographic interviewing.
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Affiliation(s)
- Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
- Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Sarah Vilpert
- Institute of social and preventive medicine, University of Lausanne, Lausanne, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
- Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Qureshi H, Carney S, Iversen A. Narrative review of the impact of clinical psychiatry attachments on attitudes to psychiatry. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.111.037820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodPsychiatry in the UK has long-standing issues in recruiting UK-trained doctors. A key potential influence on interest in psychiatry during medical school is the clinical attachment. This narrative review investigates how the clinical experience of psychiatry affects medical students' attitudes towards the specialty.ResultsWe identified 107 studies, of which 46 were included. They showed that clinical attachments in psychiatry did result in more positive attitudes towards the specialty and increased career interest. There was inconsistent evidence on whether interest was maintained, with some studies indicating that the increase is transient. Factors which may influence attitudes include attachment setting, duration and student demographics.Clinical implicationsThe results suggest a need to actively maintain interest in psychiatry throughout medical school. Research with long-term follow-up and evaluation of schemes to maintain students' interest is needed.
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Monk A, Hind D, Crimlisk H. Balint groups in undergraduate medical education: a systematic review. PSYCHOANALYTIC PSYCHOTHERAPY 2017. [DOI: 10.1080/02668734.2017.1405361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alice Monk
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
- The Medical School, The University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
- Clinical Trials Research Unit, ScHARR, The University of Sheffield, Sheffield, UK
| | - Helen Crimlisk
- The Medical School, The University of Sheffield, Sheffield, UK
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Boyer S, Chamberlain S, Pukall C. Vulvodynia attitudes in a sample of Canadian post-graduate medical trainees. CANADIAN JOURNAL OF HUMAN SEXUALITY 2017. [DOI: 10.3138/cjhs.2017-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Physicians play a critical role in addressing sexual health in medical practice, including pain during intercourse. Vulvodynia is a prevalent cause of pain, however, related training is limited and variable. In addition, physician attitudes toward pain and sexuality may affect behaviour and therefore patient outcomes. This study's objectives were to: 1) determine whether post-graduate trainees hold more positive attitudes toward women presenting with vulvovaginal pain with (versus without) an identifiable cause; and 2) examine attitudinal predictors of comfort treating vulvodynia and attitudes toward patients with this presentation. Residents in Canadian Obstetrics and Gynecology (OBGYN) and Family Medicine (FM) programs participated in an online survey (N=99). Respondents completed questionnaires related to demographics, sexuality-related training, sexual attitudes, and comfort treating and attitudes toward vulvovaginal pain and its symptoms. Residents reported significantly more positive attitudes toward patients with visible pathology versus no identifiable cause for vulvovaginal pain, regardless of medical specialty, p<.001. In OBGYN residents, general comfort discussing sexuality in medical practice significantly predicted comfort treating vulvodynia and its symptoms (p<.001), and attitudes toward women with vulvodynia (p<.05). Demographic, training, and attitudinal variables did not significantly predict vulvodynia outcome measures in FM residents. This study of medical residents identified different attitudes based on vulvovaginal pain presentation, and identified predictors of attitudes and comfort treating vulvodynia in OBGYN residents. Findings suggest pathways by which health care experiences may influence outcomes in this population, and have important implications for resident training.
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Affiliation(s)
| | - Susan Chamberlain
- Department of Obstetrics & Gynecology, Queen's University, Kingston, ON
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Moser EM, Fazio SB, Packer CD, Glod SA, Smith CD, Alguire PC, Huang GC. SOAP to SOAP-V: A New Paradigm for Teaching Students High Value Care. Am J Med 2017; 130:1331-1336.e2. [PMID: 28778492 DOI: 10.1016/j.amjmed.2017.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | - Cynthia D Smith
- American College of Physicians, Philadelphia, Pa; University of Pennsylvania, Philadelphia
| | - Patrick C Alguire
- American College of Physicians, Philadelphia, Pa; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa
| | - Grace C Huang
- Harvard Medical School, Boston, Mass; Carl J. Shapiro Institute for Education and Research at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
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83
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Silva V, Costa P, Pereira I, Faria R, Salgueira AP, Costa MJ, Sousa N, Cerqueira JJ, Morgado P. Depression in medical students: insights from a longitudinal study. BMC MEDICAL EDUCATION 2017; 17:184. [PMID: 29017594 PMCID: PMC5633876 DOI: 10.1186/s12909-017-1006-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 09/05/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Factors associated with depression of medical students are poorly understood. The purpose of this study is to determine the prevalence of depression in medical students, its change during the course, if depression persists for affected students, what are the factors associated with depression and how these factors change over time. METHODS A prospective, longitudinal observational study was conducted at the Medical School of the University of Minho, Portugal, between academic years 2009-2010 to 2012-2013. We included students who maintained their participation by annually completing a questionnaire including Beck Depression Inventory (BDI). Anxiety and burnout were assessed using the State Trait Anxiety Inventory and Maslach Burnout Inventory. Surveys on socio-demographic variables were applied to evaluate potential predictors, personal and academic characteristics and perceived difficulties. ANOVA with multiple comparisons were used to compare means of BDI score. The medical students were organized into subgroups by K-means cluster analyses. ANOVA mixed-design repeated measurement was performed to assess a possible interaction between variables associated with depression. RESULTS The response rate was 84, 92, 88 and 81% for academic years 2009-2010, 2010-2011,2011-2012 and 2012/2013, respectively. Two hundred thirty-eight medical students were evaluated longitudinally. For depression the prevalence ranged from 21.5 to 12.7% (academic years 2009/2010 and 2012/2013). BDI scores decreased during medical school. 19.7% of students recorded sustained high BDI over time. These students had high levels of trait-anxiety and choose medicine for anticipated income and prestige, reported more relationship issues, cynicism, and decreased satisfaction with social activities. Students with high BDI scores at initial evaluation with low levels of trait-anxiety and a primary interest in medicine as a career tended to improve their mood and reported reduced burnout, low perceived learning problems and increased satisfaction with social activities at last evaluation. No difference was detected between men and women in the median BDI score over time. CONCLUSIONS Our findings suggest that personal factors (anxiety traits, medicine choice factors, relationship patterns and academic burnout) are relevant for persistence of high levels of BDI during medical training. Medical schools need to identity students who experience depression and support then, as early as possible, particularly when depression has been present over time.
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Affiliation(s)
- Vanessa Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Inês Pereira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Ricardo Faria
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Ana P. Salgueira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Manuel J. Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - João J. Cerqueira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Evans DV, Krasin B, Brown K, Dobie S, Kost A. Student Perceptions About Benets From an Extracurricular Curriculum: A Qualitative Study of the Underserved Pathway. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2017; 1:13. [PMID: 32944699 DOI: 10.22454/primer.2017.153424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction Too few medical graduates choose to care for underserved populations. This qualitative study explores medical student perceptions of the benefits of participating in the Underserved Pathway (UP), a 4-year extracurricular program designed to nurture interest in, and develop skills to serve vulnerable populations. Methods Fourteen of 28 graduating students in the class of 2013 who completed the UP were interviewed. Using conventional qualitative content analysis, an iterative process was used to code transcriptions until there was high concordance among the assigned codes. The research team analyzed the data for common themes, theme saturation, and unique perspectives. Results Four major thematic areas emerged: 1) the underserved curriculum scaffold, 2) influence on career choice, 3) influence on residency choice, and 4) capacity to match. Of all participants, 78.6% thought the UP influenced their career choice, 64.3% stated the UP played a role in residency choice and rank, and 85.7% thought participation in the UP would improve match success. No single curricular component of the UP was individually responsible for career or specialty choice, or as being most useful to student understanding of the underserved. Conclusions Students noted that participation in the UP provided them with a scaffold to support their interest in underserved careers, and influenced their specialty and residency choice. They also perceived it as making them more competitive as residency applicants. This study provides medical educators with insight into the importance of building robust frameworks, even extracurricular ones, to support student interests in serving vulnerable communities.
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Affiliation(s)
- David V Evans
- Department of Family Medicine, University of Washington
| | | | - Kevin Brown
- University of California at Irvine, Psychiatry Residency
| | - Sharon Dobie
- Department of Family Medicine, University of Washington
| | - Amanda Kost
- Department of Family Medicine, University of Washington School of Medicine
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Li DG, Wong GX, Martin DT, Tybor DJ, Kim J, Lasker J, Mitty R, Salem D. Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals. BMJ Open 2017; 7:e017251. [PMID: 28765138 PMCID: PMC5642791 DOI: 10.1136/bmjopen-2017-017251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making. DESIGN In this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population. SETTING Three Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre. PARTICIPANTS 819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories. MAIN OUTCOMES AND MEASURES Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity. RESULTS A total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001). CONCLUSIONS Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.
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Affiliation(s)
- David G Li
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Gordon X Wong
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David T Martin
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - David J Tybor
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer Kim
- Stanford Medical Center, Palo Alto, California, USA
| | - Jeffrey Lasker
- New England Quality Care Alliance, Boston, Massachusetts, USA
| | - Roger Mitty
- St. Elizabeth's Medical Center, Brighton, Massachusetts, USA
| | - Deeb Salem
- Tufts Medical Center, Boston, Massachusetts, USA
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Chou CL, Teherani A. A Foundation for Vital Academic and Social Support in Clerkships: Learning Through Peer Continuity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:951-955. [PMID: 28353506 DOI: 10.1097/acm.0000000000001661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Most medical students on clerkships currently experience lack of continuity of patient care, disjointed learning, and frequent changes in supervisors. Clerkship programs with continuity of care, curriculum, and supervisors appear to benefit student learning and patient-centeredness. A fourth form of continuity is proposed: continuity of peers, in which a stable cohort of students frequently meets to process their experiences on clerkships. This structure builds on benefits previously seen in peer-assisted learning, including enhanced knowledge, technical skills, and collegial peer relationships. Additional advantages of peer continuity in clerkships include facilitated integration into the workplace, social support, and enhanced clinical and professional learning. Practical components required for a successful peer continuity structure include intentional formation of peer cohorts; regular meetings that cover didactic or clinical skills learning; frequent opportunities for reflection on patient care, professional development, and well-being; and skilled facilitators without evaluative roles. Theoretical support for peer continuity comes from social cognitive theory, communities of clinical practice, and social comparison theory. Therefore, in conjunction with empirical programs that have shown benefits of developing these structures, peer continuity should become a formalized educational structure in clerkships.
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Affiliation(s)
- Calvin L Chou
- C.L. Chou is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. A. Teherani is professor, Department of Medicine, and education researcher, Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, California
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Lahav O, Daniely N, Yalon-Chamovitz S. Interpersonal social responsibility model of service learning: A longitudinal study. Scand J Occup Ther 2017; 25:61-69. [PMID: 28573894 DOI: 10.1080/11038128.2017.1335775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Service-learning (SL) is commonly used in Occupational Therapy (OT) programs worldwide as a community placement educational strategy. However, most SL models are not clearly defined in terms of both methodology and learning outcomes. OBJECTIVES This longitudinal study explores a structured model of Service-Learning (Interpersonal Social Responsibility-Service Learning: ISR-SL) aimed towards the development of professional identity among OT students. Based on OT students experiences from the end of the course through later stages as mature students and professionals. MATERIAL AND METHODS A qualitative research design was used to explore the perceptions and experiences of 150 first, second, and third-year OT students and graduates who have participated in ISR-SL during their first academic year. RESULTS Our findings suggest that the structured, long-term relationship with a person with a disability in the natural environment, which is the core of the ISR-SL, allowed students to develop a professional identity based on seeing the person as a whole and recognizing his/her centrality in the therapeutic relationship. CONCLUSIONS AND SIGNIFICANCE This study suggests ISR-SL as future direction or next step for implementing SL in OT and other healthcare disciplines programs.
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Affiliation(s)
- Orit Lahav
- a Department of Occupational Therapy, Faculty of Health Professions , Ono Academic College , Kiryat Ono , Israel
| | - Noa Daniely
- b Occupational Therapy Department , Ono Academic College , Kiryat Ono , Israel
| | - Shira Yalon-Chamovitz
- c Israeli Institute on Cognitive Accessibility, Agudat Ami & Ono Academic College , Ono Academic College , Kiryat Ono , Israel
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Tsai TC. Twelve tips for the construction of ethical dilemma case-based assessment. MEDICAL TEACHER 2017; 39:341-346. [PMID: 28379082 DOI: 10.1080/0142159x.2017.1288862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ethical dilemma case-based examination (ethics Script Concordance Test, eSCT) is a written examination that can be delivered to a large group of examinees for the purpose of measuring high-level thinking. As it accommodates for diverse responses from experts, ethics SCT allows partial credits. The framework of ethics SCT includes a vignette with an ethical dilemma and a leading question, which asks the examinee to "agree" or "disagree", plus the shifts of prior decision by adding new information. In this article, the following tips for constructing this type of examination are provided: use "true" dilemmas, select an appropriate ethical issue, target high-level cognitive tasks, list key components, keep a single central theme, device quality scoring system, be important and plausible, be clear, select quality experts, validate, know the limitation, and be familiar with test materials. The use of eSCT to measure ethical reasoning ability appears to be both viable and desirable.
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Affiliation(s)
- Tsuen-Chiuan Tsai
- a Department of Pediatrics , Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung , Taiwan
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Chen EH, Kanzaria HK, Itakura K, Booker-Vaughns J, Yadav K, Kane BG. The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda. Acad Emerg Med 2016; 23:1362-1367. [PMID: 27442908 DOI: 10.1111/acem.13059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/29/2016] [Accepted: 07/17/2016] [Indexed: 01/17/2023]
Abstract
Shared decision making (SDM) is a patient-centered communication skill that is essential for all physicians to provide quality care. Like any competency or procedural skill, it can and should be introduced to medical students during their clerkships (undergraduate medical education), taught and assessed during residency training (graduate medical education), and have documentation of maintenance throughout an emergency physician's career (denoted as continuing medical education). A subgroup representing academic emergency medicine (EM) faculty, residents, content experts, and patients convened at the 2016 Academic Emergency Medicine Consensus Conference on SDM to develop a research agenda toward improving implementation of SDM through sustainable education efforts. After developing a list of potential priorities, the subgroup presented the priorities in turn to the consensus group, to the EM program directors (CORD-EM), and finally at the conference itself. The two highest-priority questions were related to determining or developing EM-applicable available tools and on-shift interventions for SDM and working to determine the proportion of the broader SDM curriculum that should be taught and assessed at each level of training. Educating patients and the community about SDM was also raised as an important concept for consideration. The remaining research priorities were divided into high-, moderate-, and lower-priority groups. Moreover, there was consensus that the overall approach to SDM should be consistent with the high-quality educational design utilized for other pertinent topics in EM.
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Affiliation(s)
- Esther H. Chen
- Department of Emergency Medicine; University of California, San Francisco; San Francisco CA
| | - Hemal K. Kanzaria
- Department of Emergency Medicine; University of California, San Francisco; San Francisco CA
| | - Kaoru Itakura
- Department of Emergency Medicine; Harbor-UCLA Medical Center; Los Angeles CA
| | - Juanita Booker-Vaughns
- LA Biomedical Research Institute, Community Council; Harbor-UCLA Medical Center; Los Angeles CA
| | - Kabir Yadav
- Department of Emergency Medicine; Harbor-UCLA Medical Center; Los Angeles CA
| | - Bryan G. Kane
- Department of Emergency Medicine; Lehigh Valley Health Network; Allentown PA
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90
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Taveira-Gomes I, Mota-Cardoso R, Figueiredo-Braga M. Communication skills in medical students - An exploratory study before and after clerkships. Porto Biomed J 2016; 1:173-180. [PMID: 32258571 PMCID: PMC6806961 DOI: 10.1016/j.pbj.2016.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Effective communication is the cornerstone of a fruitful patient-physician relationship. Teaching clinical communication has become a pivotal goal in medical education. However, approaches measuring the maintenance of learned skills are needed since a decline in some communication skills during medical school has been reported. OBJECTIVE Explore medical students' communication skills in a simulated clinical encounter before and after clerkships. METHODS Two-hundred-fifty-five undergraduate students attending the second year of medical course, at the Faculty of Medicine of University of Porto, completed a 1.5-h per week course over 4 months on basic communication skills. The students' final evaluation consisted in an interview with a simulated patient, assessed by a teacher using a standardized framework. Three years later, while attending clerkships, 68 students from the same population completed a re-evaluation interview following the same procedure. RESULTS Medical students maintained a communication skill mean level similar to that of the original post-training evaluation, but significant differences in specific communication abilities were detected in this group of students. Empathic attitudes and ability to collect information improved whereas interview structure and non-verbal behavior showed a decline during clerkships expressing a balance between the competencies that improved, those that declined, and those that remained unchanged. CONCLUSION Present findings emphasize the importance of patient contact, context and clinical role models on the maintenance of learned skills, underscoring the importance of an integrated approach of clinical communication teaching throughout medical school.
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Affiliation(s)
- Isabel Taveira-Gomes
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
- Child and Adolescent Psychiatry Resident at Centro Hospitalar do Porto, Portugal
| | - Rui Mota-Cardoso
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
| | - Margarida Figueiredo-Braga
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
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91
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Seif-Farshad M, Bazmi S, Amiri F, Fattahi F, Kiani M. Knowledge of medical professionalism in medical students and physicians at Shahid Beheshti University of Medical Sciences and affiliated hospitals-Iran. Medicine (Baltimore) 2016; 95:e5380. [PMID: 27828869 PMCID: PMC5106075 DOI: 10.1097/md.0000000000005380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 12/03/2022] Open
Abstract
Although medical professionalism is a fundamental aspect of competence in medicine and a distinct facet of physicians' competence, evidence suggests that the subject of professionalism is not taught or assessed as part of medical students' curricula in Iran and many other countries. Assessing the knowledge of medical students and physicians about medical professionalism seems to be helpful in identifying the weaknesses of training in the field of professionalism and devise plans for future training on the subject.The present cross-sectional, quantitative, observational, and prevalence study recruited 149 medical interns, clinical residents, physicians, and professors working in hospitals selected through stratified random sampling using a questionnaire designed by the researchers and confirmed for its validity and reliability. The results were analyzed by Stata at a significance level of 0.05.Out of 149 cases, 61.64% were male with the mean age of 30.81 years. A total of 66 participants (44.29%) (95% confidence interval [CI]: 36.44%-52.44%) had heard and 83 (55.70%) (95% CI: 47.55%-63.55%) had not heard the term "medical professionalism" before the study. After adjusting for potential confounders, age and degree did not have statistically significant difference in assessed knowledge of medical professionalism, but sex had (mean difference: 5.88, P = 0.045), and the mean of the female was significantly higher than that of the male participants. The mean percentage of correct answers was 47.67.The present study demonstrated that the medical professionals working in the national healthcare system have an unfavorable theoretical knowledge about medical professionalism in Iran; although this does not indicate that their practices are unethical, it should be noted that one of the prerequisites of possessing a high level of medical professionalism and for establishing a proper relationship between the medical community and the patients is to have a proper knowledge of this concept. Improving behaviors and performances in medical professions requires adequate training on the concepts of medical professionalism and consequently the assessment of the levels of professionalism achieved in medical professionals.
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92
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Khidir H, Weiner SG. A Call for Better Opioid Prescribing Training and Education. West J Emerg Med 2016; 17:686-689. [PMID: 27833673 PMCID: PMC5102592 DOI: 10.5811/westjem.2016.8.31204] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/06/2016] [Accepted: 08/29/2016] [Indexed: 11/11/2022] Open
Abstract
Pain is the most common complaint in the emergency department (ED), and emergency physicians face unique challenges in making opioid-related treatment decisions. Medical students and residents experience significant variation in the quality of education they receive both about opioid prescribing as well as substance-use detection and intervention in the ED. To achieve a better standard of education, clinical educators will need to (a) develop a clearer understanding of the risk for aberrant opioid prescribing in the ED, (b) recognize prescribing bias and promote uptake of evidence-based opioid prescribing guidelines in their EDs, and
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Affiliation(s)
| | - Scott G Weiner
- Harvard Medical School, Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
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93
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Screening for Sexual Dysfunction by Medical Students. J Sex Med 2016; 13:1473-81. [DOI: 10.1016/j.jsxm.2016.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/04/2016] [Accepted: 08/11/2016] [Indexed: 01/23/2023]
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94
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Parker RB, Parker PD, Larkin T, Cockburn J. A psychometric evaluation of the Gender Bias in Medical Education Scale. BMC MEDICAL EDUCATION 2016; 16:251. [PMID: 27682146 PMCID: PMC5041577 DOI: 10.1186/s12909-016-0774-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 09/20/2016] [Indexed: 05/03/2023]
Abstract
BACKGROUND Gender bias within medical education is gaining increasing attention. However, valid and reliable measures are needed to adequately address and monitor this issue. This research conducts a psychometric evaluation of a short multidimensional scale that assesses medical students' awareness of gender bias, beliefs that gender bias should be addressed, and experience of gender bias during medical education. METHODS Using students from the University of Wollongong, one pilot study and two empirical studies were conducted. The pilot study was used to scope the domain space (n = 28). This initial measure was extended to develop the Gender Bias in Medical Education Scale (GBMES). For Study 1 (n = 172), confirmatory factor analysis assessed the construct validity of the three-factor structure (awareness, beliefs, experience) and enabled deletion of redundant items. Study 2 (n = 457) tested the generalizability of the refined scale to a new sample. Combining Study 1 and 2, invariance testing for program of study and gender was explored. The relationship of the GBMES to demographic and gender politics variables was tested. The results were analyzed in R using confirmatory factor analysis and Multiple-Indicator-Multiple-Indicator-Cause models. RESULTS After analysis of the responses from the original 16-item GBMES (Study 1), a shortened measure of ten items fitted the data well (RMSEA = .063; CFI = .965; TLI = .951; Mean R-square of items = 58.6 %; reliability: .720-.910) and was found to generalize to a new sample in Study 2 (RMSEA = .068; CFI = .952; TLI = .933; Mean R-square of items = 55.9 %; reliability: .711-.892). The GBMES was found to be invariant across studies, gender, and program of study. Female students and those who supported gender equality had greater agreement for each of the factors. Likewise, postgraduate students reported higher scores on experience of gender bias than undergraduate students. CONCLUSION The GBMES provides a validated short multidimensional measure for use in research and policy. Given its good reliability across different target populations and its concise length, the GBMES has much potential for application in research and education to assess students' attitudes towards gender bias.
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Affiliation(s)
- Rhiannon B. Parker
- University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
| | - Philip D. Parker
- Institute of Positive Psychology and Education, Australian Catholic University, 25A Barker Road, Strathfield, Australia
| | - Theresa Larkin
- University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
| | - Jon Cockburn
- University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
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95
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Stratta EC, Riding DM, Baker P. Ethical erosion in newly qualified doctors: perceptions of empathy decline. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2016; 7:286-92. [PMID: 27608488 PMCID: PMC5018358 DOI: 10.5116/ijme.57b8.48e4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 08/20/2016] [Indexed: 05/24/2023]
Abstract
OBJECTIVES This study sought to understand whether UK Foundation doctors perceived the phenomena of ethical erosion and empathy decline during their initial period of clinical practice, and if so, why this occurred. METHODS This qualitative study used semi-structured interviews with nine doctors in their first year of clinical practice at Royal Bolton Hospital, UK. Participants were invited to discuss the definition of empathy, how individuals acquire and maintain empathic ability, perceptions of ethical erosion in the self and others, and how clinical experiences have influenced their empathic ability. The interviews were transcribed, and analysed to identify emergent themes. RESULTS Each participant reported a conscious acknowledgement of empathy decline in their own and their colleagues' early clinical experiences as doctors. Stressful working environments, the prioritisation of patients' physical rather than psychological well-being, and the attitudes of senior colleagues were all suggested as possible causes. Some doctors believed that specialties with reduced patient contact had a culture which precluded empathy, and influenced their own practice. In addition, some described how their value judgements of patients had affected their ability to empathise. However, all doctors perceived that empathy skills were desirable in senior clinicians, and some believed that educational interventions may be useful in arresting ethical erosion. CONCLUSIONS Newly qualified doctors are aware of ethical erosion in themselves and their colleagues as they begin clinical practice. This has serious implications for patient care. Improving working conditions may reverse this trend. Empathy skills training within undergraduate and postgraduate curricula may be a useful intervention.
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Affiliation(s)
| | | | - Paul Baker
- Health Education England (North West Office), UK
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96
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Oskvarek J, Braunstein S, Farnan J, Ferguson MK, Hahn O, Henderson T, Hong S, Levine S, Rosenberg CA, Golden DW. Medical Student Knowledge of Oncology and Related Disciplines: a Targeted Needs Assessment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:529-32. [PMID: 26153490 PMCID: PMC4706503 DOI: 10.1007/s13187-015-0876-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Despite increasing numbers of cancer survivors, non-oncology physicians report discomfort and little training regarding oncologic and survivorship care. This pilot study assesses medical student comfort with medical oncology, surgical oncology, radiation oncology, hospice/palliative medicine, and survivorship care. A survey was developed with input from specialists in various fields of oncologic care at a National Cancer Institute-designated comprehensive cancer center. The survey included respondent demographics, reports of experience with oncology, comfort ratings with oncologic care, and five clinical vignettes. Responses were yes/no, multiple choice, Likert scale, or free response. The survey was distributed via email to medical students (MS1-4) at two US medical schools. The 105 respondents were 34 MS1s (32 %), 15 MS2s and MD/PhDs (14 %), 26 MS3s (25 %), and 30 MS4s (29 %). Medical oncology, surgical oncology, and hospice/palliative medicine demonstrated a significant trend for increased comfort from MS1 to MS4, but radiation oncology and survivorship care did not. MS3s and MS4s reported the least experience with survivorship care and radiation oncology. In the clinical vignettes, students performed the worst on the long-term chemotherapy toxicity and hospice/palliative medicine questions. Medical students report learning about components of oncologic care, but lack overall comfort with oncologic care. Medical students also fail to develop an increased self-assessed level of comfort with radiation oncology and survivorship care. These pilot results support development of a formalized multidisciplinary medical school oncology curriculum at these two institutions. An expanded national survey is being developed to confirm these preliminary findings.
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Affiliation(s)
- Jonathan Oskvarek
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Jeanne Farnan
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Olwen Hahn
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Tara Henderson
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Susan Hong
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Stacie Levine
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Daniel W Golden
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA.
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97
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Shpigelman CN, Zlotnick C, Brand R. Attitudes Toward Nursing Students With Disabilities: Promoting Social Inclusion. J Nurs Educ 2016; 55:441-9. [DOI: 10.3928/01484834-20160715-04] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/01/2016] [Indexed: 11/20/2022]
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98
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Shah S, Andrades M, Basir F, Jaleel A, Azam I, Islam M, Ahmed R. Has the inclusion of a longitudinally integrated communication skills program improved consultation skills in medical students? A pilot study. J Family Med Prim Care 2016; 5:45-50. [PMID: 27453842 PMCID: PMC4943148 DOI: 10.4103/2249-4863.184622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Evidence highlights a lack of communication skills in doctors leading to dysfunctional consultations. To address this deficit, a private medical college instituted curricular reforms with inclusion of a longitudinal communication skills program. A pilot study was undertaken to evaluate the effectiveness of this program by comparing the consultation skills of medical students of this college with a medical college without a communication skills program. Methods: A 4-station Objective Structured Clinical Examination (OSCE) was conducted in the third and final year. Mann–Whitney U-test was used to compare the difference in the distribution between OSCE stations total and construct scores. Results: At the end of the third year, 21 (31.34%), students of the study site (medical college 1 [college with integrated longitudinal communication skills program]) and 31 (46.26%) students from the comparison site (medical college 2 [comparable college without communication skills program]) consented. Medical college 1 achieved a significantly higher overall mean total station score of 68.0% (standard deviation [SD] =13.5) versus 57.2% (SD = 15.4) (P < 0.001). Significantly higher mean scores were achieved on three stations. At the end of the final year, 19 students (29.3%) from medical college 1 and 22 (34%) students from medical college 2 consented. The difference in overall mean total station score reduced from 9.2% to 7.1% (70.2) (SD = 13.7) versus 63.1 (SD = 15.2) (P = 0.004). The mean scores of both colleges decreased in “Patient presenting with Hepatitis C Report” station (P values 0.004 and 0.775) and in “Patient Request for Faith Healing Therapy in Diabetes Mellitus” station (P values 0.0046 and 0.036), respectively. Conclusion: Longitudinal communication skills in an undergraduate curriculum positively impacted consultation skills. Community-based training and faculty development are required to develop effective patient-centered consultation skills.
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Affiliation(s)
- Sameena Shah
- Department of Family Medicine, Aga Khan University and Hospital, Karachi, Pakistan
| | - Marie Andrades
- Department of Family Medicine, Aga Khan University and Hospital, Karachi, Pakistan
| | - Fasia Basir
- Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Anila Jaleel
- Department of Biochemistry, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University and Hospital, Karachi, Pakistan
| | - Muhammad Islam
- Department of Community Health Sciences, Aga Khan University and Hospital, Karachi, Pakistan
| | - Rashida Ahmed
- Department of Pathology, Aga Khan University and Hospital, Karachi, Pakistan
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Abstract
In this article, we discuss current perceptions of the model physician and how these perceptions conflict with stressful realities of training environments and contribute to the staggering rates of burnout and depression faced by medical students and residents. We suggest a multi-tiered interventional approach to address these problems, with innovations for individual trainees, programs, institutions, and the health care system. Finally, we discuss the medical community's ethical obligations to ensure that it is appropriately and thoughtfully investing in the wellness of medicine's next generations of practitioners.
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Affiliation(s)
- Kathryn Baker
- Clinical instructor in the Department of Psychiatry at the University of Michigan in Ann Arbor, and the director of the University of Michigan Medical Student Mental Health and House Officer Mental Health programs
| | - Srijan Sen
- Associate professor in the Department of Psychiatry and in the Molecular and Behavioral Neuroscience Institute at the University of Michigan in Ann Arbor, and the principal investigator of the Intern Health Study
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100
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Hudson JN, Lethbridge A, Vella S, Caputi P. Decline in medical students' attitudes to interprofessional learning and patient-centredness. MEDICAL EDUCATION 2016; 50:550-9. [PMID: 27072444 DOI: 10.1111/medu.12958] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/02/2015] [Accepted: 10/19/2015] [Indexed: 05/04/2023]
Abstract
CONTEXT Interprofessional learning (IPL) is valuable in preparing health care students to work collaboratively in teams, with patients' needs at the core. Patient-centredness is the impetus for communication and collaboration in health care. Debate continues on when it is best to develop positive student attitudes towards these aspects of care. Should IPL commence early before attitudes to patients, professional stereotypes and identity are formed, or later for advanced learners with greater experience of their roles and responsibility in health care? This study explores graduate-entry medical students' attitudes to IPL and patient-centred care, on programme entry and after an early interdisciplinary clinical experience (ICE). METHODS An extended version of the Readiness for Interprofessional Learning Scale (RIPLS) was administered to four cohorts of medical students (n = 279) on entry and after the 3-week placement. This 26-item RIPLS comprised four subscales: team work and collaboration; professional identity; roles and responsibilities; and patient-centredness. The impact of the placement on students' attitudes was assessed by using repeated measures analysis of variance to compare pre- and post-ICE subscale scores. RESULTS There were significant main effects of time (pre- versus post-ICE) for the subscales of teamwork and collaboration, professional identity and patient-centredness, but not for roles and responsibilities. Scores for teamwork and collaboration, professional identity and patient-centredness were all lower post-ICE. CONCLUSIONS The students' less positive attitudes to teamwork and collaboration and professional identity may be due to the experience itself, or because it reinforced negative beliefs about the value of learning from non-medical health professionals. Perhaps the students' idealised view of their future role as a doctor was challenged by the experience, or they had an underdeveloped professional identity. Limited student experience of patients having an active role in their own health care may explain the decrease in attitudes to patient-centredness. A longitudinal qualitative study will explore these results.
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Affiliation(s)
- Judith N Hudson
- University of Newcastle, Tamworth, New South Wales, Australia
| | | | - Susan Vella
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Peter Caputi
- University of Wollongong, Wollongong, New South Wales, Australia
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