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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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102
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Cuttilan AN, Sayampanathan AA, Ho RCM. Mental health issues amongst medical students in Asia: a systematic review [2000-2015]. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:72. [PMID: 27004219 DOI: 10.3978/j.issn.2305-5839.2016.02.07] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies have shown that the stress experienced by medical students is far greater than that experienced by other university students. In this study, we aim to understand the consequent mental health issues that are experienced by medical students, particularly in Asia, via a systematic review of the current literature. METHODS Initial searches on MEDLINE, Embase and SpringerLink came up with a total of 1,033 unique articles. Studies not focusing on medical students alone, not mentioning mental health issues or not containing prevalence values were excluded. RESULTS We included 14 articles in our analysis. ADs had a prevalence of 7.04% (100/1,420). Depression was prevalent in 11.0% (1,115/10,147) of students. A total of 12.9% (54/420) and 12.9% (41/319) of male and female medical students respectively were screened for depression. Preclinical students were also 1.63 times more likely to be depressed compared to clinical students, with 98.0% (48/49) pre-clinical students having screened for depression, compared to 60% (27/45) clinical students. Home staying medical students are 1.33 times more likely to be depressed compared to hostel-stayers, with 12.1% (29/239) of home stayers being depressed compared to 9.2% (37/402) of hostel stayers. CONCLUSIONS We found that mental health issues affect a significant proportion of medical students and they are more prevalent in certain subpopulations of medical students. Our data revealed that preclinical and home staying students can be more susceptible to depression. More research should be done regarding this issue. With such information, it is hoped that appropriate interventions can be designed to improve the mental health of medical students.
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Affiliation(s)
- Amit Nirmal Cuttilan
- 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; 2 Department of Psychological Medicine, National University Hospital, Singapore
| | - Andrew Arjun Sayampanathan
- 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; 2 Department of Psychological Medicine, National University Hospital, Singapore
| | - Roger Chun-Man Ho
- 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; 2 Department of Psychological Medicine, National University Hospital, Singapore
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Imran N, Tariq KF, Pervez MI, Jawaid M, Haider II. Medical Students' Stress, Psychological Morbidity, and Coping Strategies: a Cross-Sectional Study from Pakistan. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:92-6. [PMID: 26381814 DOI: 10.1007/s40596-015-0413-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 09/03/2015] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The authors studied the prevalence of psychological morbidity, sources and severity of stresses, as well as coping strategies in Pakistani medical students. METHODS Medical students in Lahore, Pakistan, completed a cross-sectional, self-administered questionnaire in 2013 on the sources and severity of various stressors. The General Health Questionnaire-12 (GHQ-12) and Brief COPE assessed the psychological morbidity and coping strategies. RESULTS Out of 1500 students, 527 responded to the survey. The prevalence of psychological morbidity was 23.3%; 52.3% respondents showed evidence of distress. By logistic regression analysis, GHQ-12 caseness was associated with being male and occurrence of health-related stressors. The most common stressors were related to academic concerns. Coping strategies showed variation by GHQ-caseness. CONCLUSION The significant psychological morbidity and distress warrants establishing support systems to support students and bringing about evidence-based changes to teaching and evaluation systems. Adequate counseling facilities should be made available and students encouraged to seek help.
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Affiliation(s)
- Nazish Imran
- King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
| | | | | | - Masood Jawaid
- Dow University of Health Sciences, Karachi, Pakistan
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104
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Fares J, Al Tabosh H, Saadeddin Z, El Mouhayyar C, Aridi H. Stress, Burnout and Coping Strategies in Preclinical Medical Students. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:75-81. [PMID: 27042604 PMCID: PMC4791902 DOI: 10.4103/1947-2714.177299] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is acknowledged that physicians do not seek the same expert aid for themselves as they would offer their patients. In their preclinical years, medical students appear to espouse comparable behavior. To many, medicine is described as a never-ending path that places the student under heavy stress and burnout from the beginning, leaving him/her vulnerable and with insufficient coping methods. Hence, the objective of this study is to 1) explore the prevalence of stress and burnout among preclinical medical students, and 2) propose solutions to decrease stress and burnout and improve medical education in the preclinical years. A detailed scholarly research strategy using Google Scholar, Scopus, Embase, MEDLINE and PubMed was implemented to highlight key themes that are relevant to preclinical medical students' stress and burnout. Stress varied among different samples of medical students and ranged between 20.9% and 90%. Conversely, burnout ranged between 27% and 75%. Methods that help in reducing the incidence of stress and burnout by promoting strategies that focus on personal engagement, extracurricular activities, positive reinterpretation and expression of emotion, student-led mentorship programs, evaluation systems, career counseling and life coaching should be adopted.
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Affiliation(s)
- Jawad Fares
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Hayat Al Tabosh
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Zein Saadeddin
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Hussam Aridi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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105
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Affiliation(s)
- Luigi Pagliaro
- Professor Emeritus of Internal Medicine, University of Palermo, Palermo, Italy.
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106
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Phelan SM, Puhl RM, Burke SE, Hardeman R, Dovidio JF, Nelson DB, Przedworski J, Burgess DJ, Perry S, Yeazel MW, van Ryn M. The mixed impact of medical school on medical students' implicit and explicit weight bias. MEDICAL EDUCATION 2015; 49:983-92. [PMID: 26383070 PMCID: PMC4755318 DOI: 10.1111/medu.12770] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/13/2015] [Accepted: 04/21/2015] [Indexed: 05/07/2023]
Abstract
CONTEXT Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. OBJECTIVES This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity. METHODS This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change. RESULTS Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable. CONCLUSIONS Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients.
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Affiliation(s)
- Sean M Phelan
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Sara E Burke
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Rachel Hardeman
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - David B Nelson
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julia Przedworski
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sylvia Perry
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Mark W Yeazel
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michelle van Ryn
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
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Knowledge of and Attitudes toward Medical Professionalism among Students and Junior Doctors in Trinidad and Tobago. W INDIAN MED J 2015; 64:138-44. [PMID: 26360688 DOI: 10.7727/wimj.2013.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The past decade has seen an increasing focus on professionalism within the medical school curriculum. This reflects the growing demand for doctors who demonstrate empathy and uphold the altruistic values of the Hippocratic Oath. Such is often challenged by the resource-constrained environments of developing nations requiring uniquely tailored interventions within these regions. PURPOSE As part of a wider effort to develop training of medical professionalism at our institution, an initiative was pursued to assess the current knowledge about and attitudes toward medical professionalism. METHODS The study was designed as a cross-sectional descriptive study of fourth and fifth year medical students and junior doctors. A questionnaire was adapted and revised from a previously published study. Questions were grouped into categories pertaining to knowledge about professionalism and attitudes toward professionalism. Overall, 191 questionnaires were analysed (168 students and 23 doctors). RESULTS Junior doctors' scores were higher than medical students for all knowledge subscales but scores on the attitude subscales were significantly lower than medical students. Overall, in both groups, attitude scores were higher than knowledge scores. There was an overall trend of decreasing attitude scores as persons progressed through their training years and into clinical practice. CONCLUSIONS Results demonstrate limited knowledge about medical professionalism but good attitudes toward this trait. Taken together, this perhaps highlights a receptivity toward more formal training within this area that is also justified by the marked decline in attitude scores over time.
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108
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Borghi L, Johnson I, Barlascini L, Moja EA, Vegni E. Do occupational therapists’ communication behaviours change with experience? Scand J Occup Ther 2015; 23:50-6. [DOI: 10.3109/11038128.2015.1058856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lidia Borghi
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
| | | | - Luca Barlascini
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
| | - Egidio A. Moja
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
- CURA Centre, University of Milan, Milan, Italy
| | - Elena Vegni
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
- CURA Centre, University of Milan, Milan, Italy
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Feldman K, Chawla NV. Does Medical School Training Relate to Practice? Evidence from Big Data. BIG DATA 2015; 3:103-113. [PMID: 26487985 PMCID: PMC4605456 DOI: 10.1089/big.2014.0060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
On April 2nd, 2014, the Department of Health and Human Services (HHS) announced a historic policy in its effort to increase the transparency in the American healthcare system. The Center for Medicare and Medicaid Service (CMS) would publicly release a dataset containing information about the types of Medicare services, requested charges, and payments issued by providers across the country. In its release, HHS stated that the data would shed light on "Medicare fraud, waste, and abuse." While this is most certainly true, we believe that it can provide so much more. Beyond the purely financial aspects of procedure charges and payments, the procedures themselves may provide us with additional information, not only about the Medicare population, but also about the physicians themselves. The procedures a physician performs are for the most part not novel, but rather recommended, observed, and studied. However, whether a physician decides on advocating a procedure is somewhat discretionary. Some patients require a clear course of action, while others may benefit from a variety of options. This article poses the following question: How does a physician's past experience in medical school shape his or her practicing decisions? This article aims to open the analysis into how data, such as the CMS Medicare release, can help further our understanding of knowledge transfer and how experiences during education can shape a physician's decision's over the course of his or her career. This work begins with an evaluation into similarities between medical school charges, procedures, and payments. It then details how schools' procedure choices may link them in other, more interesting ways. Finally, the article includes a geographic analysis of how medical school procedure payments and charges are distributed nationally, highlighting potential deviations.
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Affiliation(s)
- Keith Feldman
- Department of Computer Science & Engineering, iCeNSA, University of Notre Dame, Notre Dame, Indiana
| | - Nitesh V. Chawla
- Department of Computer Science & Engineering, iCeNSA, University of Notre Dame, Notre Dame, Indiana
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111
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Busch AK, Rockenbauch K, Schmutzer G, Brähler E. Do medical students like communication? Validation of the German CSAS (Communication Skills Attitude Scale). GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2015; 32:Doc11. [PMID: 25699103 PMCID: PMC4330630 DOI: 10.3205/zma000953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/19/2014] [Accepted: 10/30/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Attitudes towards communication skills of medical undergraduates can be gathered using the Communication Skills Attitude Scale (CSAS). We aimed to develop a German version of the CSAS (CSAS-G) in order to explore attitudes towards communication skills in a German cohort. Additionally the potential influence of demographic factors was examined. METHODS We realized the CSAS-G and conducted a survey with 529 participants from 3 different years of study. We then carried out an explorative as well as confirmatory factor analysis and compared the attitudinal scores. Multiple regression analysis was performed. RESULTS The confirmatory analysis confirmed the two-subscale system revealed by the explorative factor analysis. Students indicate low levels of negative attitudes and moderate levels of positive attitudes. Attitudinal scores differ significantly in relation to gender. CONCLUSION The CSAS-G can be used in German cohorts to evaluate attitudes towards communication skills. Medical students in our study show basically a positive approach. Further investigation is necessary to explore and understand attitudes towards communication skills of German medical students.
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Affiliation(s)
- Anne-Kathrin Busch
- University Hospital Leipzig, Department of Psychic Health, Division for Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Katrin Rockenbauch
- University Hospital Leipzig, Department of Psychic Health, Division for Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Gabriele Schmutzer
- University Hospital Leipzig, Department of Psychic Health, Division for Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Elmar Brähler
- University Hospital Leipzig, Department of Psychic Health, Division for Medical Psychology and Medical Sociology, Leipzig, Germany
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112
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Aper L, Veldhuijzen W, Dornan T, van de Ridder M, Koole S, Derese A, Reniers J. "Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:77-84. [PMID: 25448312 DOI: 10.1016/j.pec.2014.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 09/02/2014] [Accepted: 09/19/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility? METHODS Six focus groups were conducted with (pre-)/clerkship students. RESULTS Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models. CONCLUSION Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor. PRACTICE IMPLICATIONS When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.
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113
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Kogan JR, Lapin J, Aagaard E, Boscardin C, Aiyer MK, Cayea D, Cifu A, Diemer G, Durning S, Elnicki M, Fazio SB, Khan AR, Lang VJ, Mintz M, Nixon LJ, Paauw D, Torre DM, Hauer KE. The effect of resident duty-hours restrictions on internal medicine clerkship experiences: surveys of medical students and clerkship directors. TEACHING AND LEARNING IN MEDICINE 2015; 27:37-50. [PMID: 25584470 DOI: 10.1080/10401334.2014.979187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED PHENOMENON: Medical students receive much of their inpatient teaching from residents who now experience restructured teaching services to accommodate the 2011 duty-hour regulations (DHR). The effect of DHR on medical student educational experiences is unknown. We examined medical students' and clerkship directors' perceptions of the effects of the 2011 DHR on internal medicine clerkship students' experiences with teaching, feedback and evaluation, and patient care. APPROACH Students at 14 institutions responded to surveys after their medicine clerkship or subinternship. Students who completed their clerkship (n = 839) and subinternship (n = 228) March to June 2011 (pre-DHR historical controls) were compared to clerkship students (n = 895) and subinterns (n = 377) completing these rotations March to June 2012 (post-DHR). Z tests for proportions correcting for multiple comparisons were performed to assess attitude changes. The Clerkship Directors in Internal Medicine annual survey queried institutional members about the 2011 DHR just after implementation. FINDINGS Survey response rates were 64% and 50% for clerkship students and 60% and 48% for subinterns in 2011 and 2012 respectively, and 82% (99/121) for clerkship directors. Post-DHR, more clerkship students agreed that attendings (p =.011) and interns (p =.044) provided effective teaching. Clerkship students (p =.013) and subinterns (p =.001) believed patient care became more fragmented. The percentage of holdover patients clerkship students (p =.001) and subinterns (p =.012) admitted increased. Clerkship directors perceived negative effects of DHR for students on all survey items. Most disagreed that interns (63.1%), residents (67.8%), or attendings (71.1%) had more time to teach. Most disagreed that students received more feedback from interns (56.0%) or residents (58.2%). Fifty-nine percent felt that students participated in more patient handoffs. INSIGHTS: Students perceive few adverse consequences of the 2011 DHR on their internal medicine experiences, whereas their clerkship director educators have negative perceptions. Future research should explore the impact of fragmented patient care on the student-patient relationship and students' clinical skills acquisition.
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Affiliation(s)
- Jennifer R Kogan
- a Department of Medicine , Perelman School of Medicine at the University of Pennsylvania , Philadelphia , Pennsylvania , USA
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Yamada Y, Klugar M, Ivanova K, Oborna I. Psychological distress and academic self-perception among international medical students: the role of peer social support. BMC MEDICAL EDUCATION 2014; 14:256. [PMID: 25430069 PMCID: PMC4251849 DOI: 10.1186/s12909-014-0256-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/18/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND Psychological distress among medical students is commonly observed during medical education and is generally related to poor academic self-perception. We evaluated the role of peer social support at medical schools in the association between psychological distress and academic self-perception. METHODS An online survey was conducted in a medical degree program for 138 international students educated in English in the Czech Republic. The Medical Student Well-Being Index was used to define the students' psychological distress. Perceived peer social support was investigated with the Multidimensional Scale of Perceived Social Support. Poor academic self-perception was defined as the lowest 30% of a subscale score of the Dundee Ready Education Environment Measure. Analyses evaluated the presence of additive interactions between psychological distress and peer social support on poor academic self-perception, adjusted for possible confounders. RESULTS Both psychological distress and low peer social support were negatively associated with poor academic self-perception, adjusted for local language proficiency and social support from family. Students with psychological distress and low peer social support had an odds ratio of 11.0 (95% confidence interval (CI): 2.1-56.6) for poor academic self-perception as compared with those without distress who had high peer social support. The presence of an additive interaction was confirmed in that the joint association was four times as large as what would have been expected to be on summing the individual risks of psychological distress and low peer social support (synergy index = 4.5, 95% CI: 1.3-14.9). CONCLUSIONS Psychological distress and low peer social support may synergistically increase the probability of poor academic self-perception among international medical students. Promoting peer social relationships at medical school may interrupt the vicious cycle of psychological distress and poor academic performance.
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Affiliation(s)
- Yukari Yamada
- />Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hnevotinska 3, Olomouc, 775 15 Czech Republic
| | - Miloslav Klugar
- />Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hnevotinska 3, Olomouc, 775 15 Czech Republic
| | - Katerina Ivanova
- />Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hnevotinska 3, Olomouc, 775 15 Czech Republic
| | - Ivana Oborna
- />Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hnevotinska 3, Olomouc, 775 15 Czech Republic
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Benbassat J. Changes in wellbeing and professional values among medical undergraduate students: a narrative review of the literature. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2014; 19:597-610. [PMID: 24615278 DOI: 10.1007/s10459-014-9500-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 02/24/2014] [Indexed: 05/28/2023]
Abstract
BACKGROUND Educators are concerned by the high prevalence of emotional distress among medical students, and by the alleged decline in their humanitarian values. OBJECTIVE To re-examine these concerns by reviewing studies of medical students' wellbeing and development. METHOD Narrative review of the literature. MAIN FINDINGS (a) Medical students' emotional distress increases during their undergraduate training. However, although higher than in the general population, the prevalence of distress among medical students is similar to that among other university students. (b) Medical students' distress is independently related to endogenous factors (personality traits and life events) and to their perception of the medical learning environment. (c) Medical students do not display a measurable increase in moral reasoning, empathy and tolerance of uncertainty. (d) Students' wellbeing, moral development, reflectivity and tolerance of uncertainty have been shown to be interrelated, and associated with clinical performance. CONCLUSIONS The findings of this review endorse the concerns about the wellbeing and development of undergraduate medical students. The design of the reviewed studies does not permit inferences about causality. Yet, these findings are consistent with the hypothesis that medical training causes emotional distress that delays students' development and affects their clinical performance.
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Affiliation(s)
- Jochanan Benbassat
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, PO Box 3886, 91037, Jerusalem, Israel,
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Grigorian A, Sicklick JK, Kingham TP. International surgical residency electives: a collaborative effort from trainees to surgeons working in low- and middle-income countries. JOURNAL OF SURGICAL EDUCATION 2014; 71:694-700. [PMID: 24776855 PMCID: PMC6082620 DOI: 10.1016/j.jsurg.2014.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/25/2014] [Accepted: 03/04/2014] [Indexed: 05/22/2023]
Abstract
In today's ever-globalizing climate, the academic sector bears a certain responsibility to incorporate global health opportunities into residency training programs. The worldwide unmet surgical need has been growing; it has been estimated by the World Health Organization that by 2030, surgical diseases will contribute significantly to the burden of global health. International electives (IE) offered during training may partially address this growing need. In addition, it can help trainees develop a heightened awareness of the social determinants of health in resource-limited areas, as well as gain insight into different cultures, health beliefs, and pathologic conditions. General surgery residency programs that offer IE may also stand to benefit by attracting a broader applicant pool, as well as by having the ability to train residents to rely less upon expensive tests and equipment, while further developing residents' physical examination and communications skills. The challenges that IE pose for trainees include the required adaptation to an environment devoid of an advanced and modern medical system, and a difficulty in learning a new language, culture, and local customs. However, IE may also be hazardous for home institutions as they may drain local resources and take limited educational experiences away from local providers. Despite the active promotion of international volunteerism by the American Board of Surgery, few surgery residency programs offer IE as part of the curriculum, with cost and supervision being the major obstacles to overcome. Consequently, it may be difficult to generate American surgical leaders in international health. In this article, we outline the steps needed to bring IE to an institution and how general surgery residency programs can help bridge the gap between surgeons in high-income countries and the growing surgical needs of the international community.
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Affiliation(s)
- Areg Grigorian
- University of California, San Diego School of Medicine, La Jolla, California.
| | - Jason K Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California
| | - T Peter Kingham
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgeons OverSeas (SOS), New York, New York
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Hendelman W, Byszewski A. Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment. BMC MEDICAL EDUCATION 2014; 14:139. [PMID: 25004924 PMCID: PMC4102062 DOI: 10.1186/1472-6920-14-139] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 07/03/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Acquiring the values of medical professionalism has become a critical issue in medical education. The purpose of this study was to identify lapses in professionalism witnessed by medical students during their four year MD curriculum, and to categorize, from the students' perspective, who was responsible and the settings in which these occurred. METHODS An electronic survey, developed by faculty and medical students, was sent to all students with two email reminders. It included quantitative responses and some open-ended opportunities for comments. All analyses were performed with SAS version 9.1. RESULTS The response rate was 45.6% (255 of 559 students) for all four years of the medical school curriculum. Thirty six percent of students had witnessed or been part of an exemplary demonstration of professionalism; 64% responded that they had witnessed a lapse of professionalism. At the pre-clerkship level, the most frequent lapses involved students: arrogance (42.2%), impairment (24.2%), followed by cultural or religious insensitivity (20.5%). At the clerkship level of training, where students are exposed to real clinical situations, the lapses involved primarily faculty (including preceptor and clinician) or other staff; these included arrogance (55.3%), breach of confidentiality (28.3%), and cultural or religious insensitivity (26.6%); impairment involved mostly students (25.5%). These findings are analyzed from the perspective of role modeling by faculty and in the context of the learning environment. CONCLUSIONS Medical students witnessed a lapse of professionalism involving both fellow students as well as faculty and administrative staff, in several domains. Results from this study emphasize the importance of role modeling and the need for faculty development, to improve the learning environment. This study adds to the limited emerging literature on the forces that influence medical student professional identity formation.
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Affiliation(s)
- Walter Hendelman
- Department of Cellular & Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Anna Byszewski
- Professor of Medicine, Director of Professionalism, undergraduate curriculum, Faculty of Medicine, University of Ottawa, Division of Geriatrics, The Ottawa Hospital, Affiliate Investigator, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
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Bruno DM, Imperato PJ, Szarek M. The correlation between global health experiences in low-income countries on choice of primary care residencies for graduates of an urban US medical school. J Urban Health 2014; 91:394-402. [PMID: 24091733 PMCID: PMC3978151 DOI: 10.1007/s11524-013-9829-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study sought to determine whether medical students who participate in a global health elective in a low-income country select residencies in primary care at higher rates compared with their classmates and US medical graduates in general. Given the projected increase in demand for primary care physicians, particularly in underserved areas, understanding possible factors that encourage training in primary care or enhance interest in the care of underserved populations may identify opportunities in medical school training. The authors used data from the Office of Student Affairs, SUNY Downstate College of Medicine and the National Residency Matching Program to compare rates of primary care residency selection from 2004 to 2012. Residency selections for students who participated in the SUNY Downstate School of Public Health Global Health Elective were compared with those of their classmates and with residency match data for US seniors. In 7 of the 8 years reviewed, students who participated in the SUNY Downstate School of Public Health Global Health Elective selected primary care residencies at rates higher than their classmates. Across years, 57% of the students who completed the elective matched to primary care residences, which was significantly higher than the 44% for the remainder of Downstate's medical student class (p = 0.0023). In 6 of the 8 years, Downstate students who participated in the Global Health Elective selected primary care residencies at rates higher than US medical school seniors in general; rates were the same for both Downstate Global Health Elective students and US medical school seniors in 2009. Students who participated in a global health experience in a low-income country selected primary care residencies at higher rates than their classmates and US medical school graduates in general. Understanding how these experiences correlate with residency selection requires further investigation; areas of future study are discussed.
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Affiliation(s)
- Denise Marie Bruno
- Department of Community Health Sciences, State University of New York, Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, , Box 43, , Brooklyn, NY, 11203, USA,
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Mavor KI, McNeill KG, Anderson K, Kerr A, O'Reilly E, Platow MJ. Beyond prevalence to process: the role of self and identity in medical student well-being. MEDICAL EDUCATION 2014; 48:351-60. [PMID: 24606619 DOI: 10.1111/medu.12375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/12/2013] [Accepted: 09/06/2013] [Indexed: 05/15/2023]
Abstract
CONTEXT Problematic stress levels among medical students have been well established. This stress can lead to depression, suicidal ideation, substance abuse, burnout and cynicism, having a negative effect on students and their patients. METHODS We propose to move towards examining the processes underlying well-being in some medical students and vulnerability in others. We draw upon social psychological literature to propose that self-complexity, medical student identity and associated norms all have the capacity to influence medical students' well-being in both positive and negative ways. RESULTS We identify two key dilemmas facing medical students with regard to the social psychological factors investigated. First, a diverse set of interests and a high level of self-complexity is thought to buffer against the effects of stress and might also be beneficial for medical practitioners, but the intensive nature of medical education makes it difficult for students to pursue outside interests, leading to a strongly focused identity. Second, a strong group identity is associated with high levels of social support and improved well-being, but unhealthy group norms may have a greater influence on individuals who have a strong group identity, encouraging them to engage in behaviours that place their well-being at risk. A model is proposed outlining how these potentially contradictory social psychological processes may combine to impact upon medical students' well-being. CONCLUSIONS There is great scope for investigating the role of self-complexity, identity and norms in the medical education context, with room to investigate each of these factors alone and in combination. We highlight how our proposed model can inform medical educators as to the students who may be most vulnerable to the effects of stress and the potential interventions from which they may benefit. We conclude that social psychological factors make a valuable contribution to understanding the complex issue of well-being in medical education.
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Affiliation(s)
- Kenneth I Mavor
- ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia; School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
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Mader EM, Roseamelia C, Morley CP. The temporal decline of idealism in two cohorts of medical students at one institution. BMC MEDICAL EDUCATION 2014; 14:58. [PMID: 24655727 PMCID: PMC3994310 DOI: 10.1186/1472-6920-14-58] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/18/2014] [Indexed: 05/28/2023]
Abstract
BACKGROUND A number of studies have indicated that students lose idealistic motivations over the course of medical education, with some identifying the initiation of this decline as occurring as early as the second year of the traditional US curricula. This study builds on prior work testing the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school. METHODS The original study sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning and end of academic year 2010, on three proxies for idealism. The current study extends that work by administering the same survey items to the same student cohorts at the end of their third and fourth years (MS3 and MS4), respectively. Survey topics included questions on: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions. Linear regression was then used to test the effect of the six cohort/time-points on each composite variable, controlling for demographic characteristics. RESULTS Idealism in medicine decreased (β = -.113, p < .001) while emphasis on employment and job security increased (β = .146, p < .001) as motivators of pursuing a career in medicine at each medical school stage and time period. Students were more likely to be motivated by student debt over interest in content in specialty choice (β = .077, p = .004) across medical school stages. Negative attitudes towards primary care were most sensitive to MS group and time effects. Both negative/antagonistic views (β = .142, p < .001) and negative/sympathetic views (β = .091, p < .001) of primary care increased over each stage. CONCLUSIONS Our results provide further evidence that declines in medical student idealism may occur as early as the second year of medical education. Additionally, as students make choices in their medical careers, such as specialty choice or consideration of primary care, the influences of job security, student debt and social status increasingly outweigh idealistic motivations.
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Affiliation(s)
- Emily M Mader
- Department of Family Medicine, SUNY Upstate Medical University, 750 E. Adams Street, MIMC 200, Syracuse, NY 13066, USA
| | - Carrie Roseamelia
- Department of Family Medicine, SUNY Upstate Medical University, 750 E. Adams Street, MIMC 200, Syracuse, NY 13066, USA
| | - Christopher P Morley
- Department of Family Medicine, SUNY Upstate Medical University, 750 E. Adams Street, MIMC 200, Syracuse, NY 13066, USA
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
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Gąsiorowski J, Rudowicz E. Expectations, experiences, and attitude change during medical school: through the eyes of Polish medical students. TEACHING AND LEARNING IN MEDICINE 2014; 26:217-224. [PMID: 25010231 DOI: 10.1080/10401334.2014.914942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Pressures related to medical training influence individual experiences in the course of study, which in turn can lead to changes in students' professional attitudes. PURPOSES The aim of this investigation was to explore expectations, experiences, and attitude changes among Polish students as they progressed through a medical university. METHODS The study used a longitudinal approach in which the same cohort of students was surveyed over time, with the same questionnaire administered, at the end of Year 1 and Year 6. RESULTS The results showed that the disparity between students' expectations about studying medicine and the reality increased between Year 1 and Year 6 (p<.0001). The biggest gap concerned "technical support" and "contacts with faculty"-the observed effect size was medium with the respective Cohen's d values 0.507 and 0.368. Students in Year 1 were most disappointed by the "lack of support from faculty and their lack of interest in teaching," whereas, in Year 6, students were most concerned about an approach to teaching that equipped them in theoretical knowledge at the expense of practical skills. Students in Year 6 noticed more changes in themselves and their perception of the world as a result of medical training than students in Year 1. However, the proportion of positive changes to negative ones was 5.4:1 for Year 1 and 1.4:1 for Year 6 students. CONCLUSIONS Our findings show that medical training constitutes a strong socializing experience, which has positive and negative impacts. Negative changes perceived by students include an increase in distrust and cynicism, whereas positive changes consist of enhanced maturity, self-confidence, and empathy, which are likely to have an impact on future doctors' professional practice.
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Affiliation(s)
- Jakub Gąsiorowski
- a Department of Medical History and Ethics , Pomeranian Medical University , Szczecin , Poland
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Erogul M, Singer G, McIntyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. TEACHING AND LEARNING IN MEDICINE 2014; 26:350-6. [PMID: 25318029 DOI: 10.1080/10401334.2014.945025] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Medical students experience a high burden of stress and suffer elevated rates of depression, burnout, and suicide compared to the general population, yet there is no consensus on how to address student wellness. PURPOSES The purpose of this study was to determine whether an abridged mindfulness based stress reduction (MBSR) intervention can improve measures of wellness in a randomized sample of 1st-year medical students. METHODS Fifty-eight participants were randomized to control or 8-week MBSR intervention and then invited to participate in the study. All participants were assessed using the Perceived Stress Scale (PSS), the Resilience Scale (RS), and Self-Compassion Scale (SCS) at 3 separate time points: baseline, at the conclusion of the study intervention (8 weeks), and at 6 months after the conclusion of the intervention. The intervention consisted of 75 minutes of weekly class time, suggested meditation at home, and a half-day retreat in the last week. RESULTS The intervention group achieved significant increase on SCS scores both at the conclusion of the study (0.58, p=.002), 95% confidence interval (CI) [0.23, 0.92], and at 6 months (0.56, p=.001), 95% CI [0.25, 0.87]. PSS scores achieved significant reduction at the conclusion of the study (3.63, p=.03), 95% CI [0.37, 6.89], but not at 6 months poststudy (2.91, p=.08), 95% CI [-0.37, 6.19]. The study did not demonstrate a difference in RS after the intervention, though RS was significantly correlated with both SCS and PSS. CONCLUSIONS An abridged MBSR intervention improves perceived stress and self-compassion in 1st-year medical students and may be a valuable curricular tool to enhance wellness and professional development.
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Affiliation(s)
- Mert Erogul
- a Department of Emergency Medicine , SUNY Downstate School of Medicine , Brooklyn , New York , USA
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Abstract
BACKGROUND The changing demographics of societies mean that medical students worldwide must be sufficiently prepared to care competently for patients with dementia through development of appropriate knowledge, skills, and attitudes. No previous research had explored undergraduate medical students' attitudes toward people with dementia. METHODS An adapted version of the Approaches to Dementia Questionnaire (ADQ) was completed by 501 medical undergraduates in years 1, 3, and 5 of their degree programs in the UK and Malaysia. Non-parametric statistical analysis focused on any differences between year groups and geographical locations. RESULTS The mean ADQ response indicated a generally positive attitude across the sample, comparable with other healthcare professionals previously surveyed. Year 3 and year 5 students expressed significantly more positive attitudes than year 1 students. Year 1 students based in the UK expressed significantly more positive attitudes than year 1 student based in Malaysia, but there were no significant differences between year 3 students based in different locations. CONCLUSION The more positive attitudes found amongst year 3 and year 5 students compared to year 1 may be a result of teaching emphasizing a person-centered approach. The differences between entry-level students from Malaysia and the UK may reflect variance in cultural norms and expectations, or the ADQ's "Western" origin. Medical schools aiming to equip students with dementia-specific skills and knowledge can draw on the generally positive attitudes found in this study.
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Vora RS, Kinney MN. Connectedness, sense of community, and academic satisfaction in a novel community campus medical education model. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:182-7. [PMID: 24280857 DOI: 10.1097/acm.0000000000000072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Developing a sense of community and establishing connectivity are important in enhancing learners' success and preventing their sense of isolation. The A.T. Still University School of Osteopathic Medicine in Arizona (SOMA) has implemented a novel approach to medical education in which, beginning in the second year, students are geographically dispersed to 11 community campuses associated with community health centers around the United States, at both inner-city and rural locations. This study assessed students' sense of community, academic satisfaction, and level of connectedness in their first through fourth years of medical school at SOMA. METHOD The Rovai Classroom Community Scale and open-ended questions were administered via an online survey instrument to 412 students enrolled at SOMA for the 2011-2012 academic year. Participation was voluntary, and all results were anonymous. Data were analyzed using one-way ANOVA to compare results between classes. RESULTS Comparisons revealed an increasing degree of isolation and a decreasing sense of community and academic satisfaction progressing from the first through fourth years of medical school. Students suggested possible solutions that may be applied to medical schools and other graduate schools to improve the level of connectedness for students who are learning at a distance. CONCLUSIONS Connectivity, sense of community, and academic satisfaction may decrease for students in undergraduate medical education participating in a combination of distance learning and intermittent in-person activities. Interventions have the potential to improve these parameters. Long-term follow-up of students' satisfaction is suggested.
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Affiliation(s)
- Rupal S Vora
- Dr. Vora is associate professor of internal medicine, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona. Ms. Kinney is curriculum assessment analyst, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona
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Fine AG, Zhang T, Hwang SW. Attitudes towards homeless people among emergency department teachers and learners: a cross-sectional study of medical students and emergency physicians. BMC MEDICAL EDUCATION 2013; 13:112. [PMID: 23968336 PMCID: PMC3765267 DOI: 10.1186/1472-6920-13-112] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/16/2013] [Indexed: 05/29/2023]
Abstract
BACKGROUND Medical students' attitudes and beliefs about homeless people may be shaped by the attitudes of their teachers and one of the most common sites for learning about homeless patients is the emergency department. The objective of this study was to determine if medical students in the preclinical and clinical years and emergency medicine faculty and residents have different attitudes and beliefs about homeless people. METHODS The Health Professional Attitudes Toward the Homeless Inventory (HPATHI), was administered to all medical students, and emergency medicine physicians and residents at a large academic health sciences center in Canada. The HPATHI examines attitudes, interest and confidence on a 5-point Likert scale. Differences among groups were examined using the Kruskal Wallis test and Pearson's chi-square test. RESULTS The HPATHI was completed by 371 individuals, for an overall response rate of 55%. Analysis of dichotomized median and percentage results revealed 5/18 statements were significant by both methods. On the attitudes subscales physicians and residents as a group were more negative for 2/9 statements and on the confidence subscale more positive for 1/4 statements. The interest subscale achieved overall statistical significance with decreased positive responses among physicians and residents compared to medical students in 2/5 statements. CONCLUSION This study revealed divergences in attitudes, interests and beliefs among medical students and emergency medicine physicians and residents. We offer strategies for training interventions and systemic support of emergency faculty. Emergency medicine physicians can examine their role in the development of medical students through both formal and informal teaching in the emergency department.
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Affiliation(s)
- Alison G Fine
- Department of Family Medicine, University of Manitoba, Winnipeg, MN, Canada
| | - Tony Zhang
- Department of Internal Medicine, Western University, London, ON, Canada
| | - Stephen W Hwang
- Centre for Research on Inner City Health, St. Michael’s Hospital, Division of General Internal Medicine, University of Toronto, Toronto, Canada
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Morley CP, Roseamelia C, Smith JA, Villarreal AL. Decline of medical student idealism in the first and second year of medical school: a survey of pre-clinical medical students at one institution. MEDICAL EDUCATION ONLINE 2013; 18:21194. [PMID: 23968751 PMCID: PMC3750194 DOI: 10.3402/meo.v18i0.21194] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 05/27/2023]
Abstract
BACKGROUND Idealism declines in medical students over the course of training, with some studies identifying the beginning of the decline in year 3 of US curricula. PURPOSES This study tested the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school. METHODS We sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning (T1) and end (T2) of academic year 2010 on three proxies for idealism, including items asking about: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions; linear regression was then used to test the effect of on each LCV, controlling for race, ethnicity, rural or urban origins, gender, and marital status. RESULTS MS2s placed more emphasis on status/income concerns (β=0.153, p<0.001), and much less emphasis on idealism as a motivator (β=-0.081, p=0.054), in pursuing a medical career; more likely to consider lifestyle and family considerations (β=0.098, p=0.023), and less likely to consider idealistic motivations (β=-0.066, p=NS); and were more likely to endorse both negative/antagonistic (β=0.122, p=0.004) and negative/sympathetic (β=0.126, p=0.004) attitudes toward primary care. CONCLUSIONS The results are suggestive that idealism decline begins earlier than noted in other studies, implying a need for curricular interventions in the first two years of medical school.
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Affiliation(s)
- Christopher P Morley
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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Newton BW. Walking a fine line: is it possible to remain an empathic physician and have a hardened heart? Front Hum Neurosci 2013; 7:233. [PMID: 23781181 PMCID: PMC3678078 DOI: 10.3389/fnhum.2013.00233] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/15/2013] [Indexed: 12/22/2022] Open
Abstract
Establishing an empathic physician-patient relationship is an essential physician skill. This chapter discusses the sexually dimorphic aspects of the neural components involved in affective and cognitive empathy, and examines why men and women medical students or physicians express different levels of empathy. Studies reveal levels of medical student affective or cognitive empathy can help reveal which medical specialty a student will enter. The data show students or physicians with higher empathy enter into specialties characterized by large amounts of patient contact and continuity of care; and individuals with lower levels of empathy desire specialties having little or no patient contact and little to no continuity of care. Burnout and stress can decrease the empathy physicians had when they first entered medical school to unacceptable levels. Conversely, having a too empathetic physician can let patient conditions and reactions interfere with the ability to provide effective care. By learning to blunt affective empathic responses, physicians establish a certain degree of empathic detachment with the patient in order to provide objective care. However, a physician must not become so detached and hardened that their conduct appears callous, because it is still important for physicians, especially those in specialties with a large amount of patient contact, to use empathic communication skills.
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Affiliation(s)
- Bruce W. Newton
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical SciencesLittle Rock, AR, USA
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Bombeke K, Symons L, Mortelmans D, Debaene L, Schol S, Van Royen P, De Winter B. 'More shades of grey in my answers': an interview study revisiting attitude erosion during clerkships. MEDICAL EDUCATION 2013; 47:476-484. [PMID: 23574060 DOI: 10.1111/medu.12102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
CONTEXT Small declines in patient-centred attitudes during medical education have caused great concern. Although some of the self-report scales applied have solid psychometric foundations, validity evidence for the interpretation of attitude erosion during clerkships remains weak. OBJECTIVES We sought to address this gap in a qualitative study of the relationships between scores on four commonly used attitude scales and participants' experiences and reflections. Our aim was to gain a better understanding of the score changes from the participants' perspectives. METHODS We conducted semi-structured interviews with 15 junior doctors from a cohort (n = 37) that had previously shown a small decline in patient-centred attitudes during clerkships, measured on four self-report scales. In the interviews, we explored interviewees' experiences of their development of patient-centredness and subsequently discussed their scale scores, particularly for those items that contributed to a rise or decline in scores. We analysed the data using a process of constant comparison among personal experiences, scale scores and participants' explanations of score changes, applying the coding techniques of grounded theory. RESULTS The analysis revealed important response distortions that might be responsible for small declines in scores during clerkships separately from changes in attitudes. The drastic alterations to the participants' frame of reference, attributable to the transition to clinical practice, represented the most prominent cause of distortion. More nuanced, context-specific, patient-centred reasoning resulted in more neutral responses after clerkships, paradoxically causing a decline in scores. In addition to response distortions, the interviews revealed shortcomings in content validity such as an 'extreme' construct of patient-centredness. CONCLUSIONS This study calls into question the validity of the interpretation of attitude erosion during clerkships. The findings suggest that small declines in scores on self-report attitude scales are related to a recalibration of trainees' understandings of patient-centredness as they grow more clinically experienced. The evolved construct of patient-centredness and the way attitudes are measured require special attention in the development of future instruments.
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Affiliation(s)
- Katrien Bombeke
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.
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Pagnin D, De Queiroz V, De Oliveira Filho MA, Gonzalez NVA, Salgado AET, Cordeiro e Oliveira B, Lodi CS, Melo RMDS. Burnout and career choice motivation in medical students. MEDICAL TEACHER 2013; 35:388-94. [PMID: 23458255 DOI: 10.3109/0142159x.2013.769673] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Burnout is a stress-induced syndrome, which affects medical students. Some environmental and personal factors can favor burnout onset and its serious consequences as dropping out, sleep disorders, depression, and suicide. The motivation for choosing medicine is a personal aspect that can modulate the distress with academic demands. METHODS We applied self-administered questionnaires in 277 medical students to investigate the predictive role of career choice motivations on burnout dimensions. Specifically, we studied the influence of the main reasons for choosing medicine on emotional exhaustion, cynicism, and academic efficacy. RESULTS Intellectual curiosity, professional autonomy, altruism, and interest in human relationships were the most common reasons for choosing medicine. However, the medical students motivated by personal illness or family member's illness or death revealed a significant greater emotional exhaustion when compared with the students with other motivations. CONCLUSION The students who apply for medical school motivated by illness/death experiences are at a great risk for burnout. We suggest that students who are at risk for emotional exhaustion can be identified at the admission of medical school. Primary prevention strategies for burnout should consider this risk group.
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Affiliation(s)
- Daniel Pagnin
- Department of Psychiatry and Mental Health, Institute of Community Health, Fluminense Federal University, Brazil.
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Jones TW. Creating a longitudinal environment of awareness: teaching professionalism outside the anatomy laboratory. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:304-308. [PMID: 23348091 DOI: 10.1097/acm.0b013e318280f075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anatomy educators have long understood the role that professionalism education plays in the dissection laboratory. The process of dissecting human material forces students to address such issues as human mortality, their responsibility to the vulnerability of the deceased, their privileged position in society, and their commitment to scientific ideals. Educators have offered a wealth of opinions and curricula dedicated to teaching professionalism in first-year anatomy courses. That they have risen to this challenge is laudable. However, professionalism education is a longitudinal process of acculturation. What happens, then, to students after they leave the anatomy classroom? As it is not taught in other basic science courses, professionalism education effectively becomes a null curriculum, teaching students to compartmentalize professionalism questions so that they can be addressed in anatomy courses or during dedicated professionalism course work. In their training, medical students spend 4 to 12 years navigating this shifting environment of hidden, null, or explicit curricula, which have a significant impact on their attitudes and character.In this perspective, the author highlights, from his experience as a medical student, specific professionalism challenges in anatomy--such as encountering mortality, enacting contracts with society and those who are most vulnerable, and upholding scientific excellence--and discusses how these challenges are addressed by anatomy educators. He then provides analogous examples of opportunities to teach professionalism in other basic science courses, such as pathology, microbiology, and pharmacology. He concludes by describing the goal of incorporating professionalism into all basic science courses--a longitudinal, cohesive environment of awareness.
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Exploring the hidden curriculum: a qualitative analysis of clerks' reflections on professionalism in surgical clerkship. Am J Surg 2013; 205:426-33. [PMID: 23313441 DOI: 10.1016/j.amjsurg.2012.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 11/29/2012] [Accepted: 12/07/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Professionalism is an important part of the hidden curriculum that is gaining attention in surgical education. McMaster University, Hamilton, Ontario, Canada, has introduced a small group discussion model using critical incident reports (CIRs) to elicit students' reflections on ethical, communication, and professionalism challenges during surgical clerkship. We described the themes identified by surgical clerks in their CIRs. METHODS Using thematic analysis, 4 investigators coded 64 CIRs iteratively until conceptual saturation. Rigor and validity were ensured throughout the process. Data were further explored to compare the CIRs of junior and senior clerks. RESULTS Twenty-seven themes and 4 relationship domains emerged: the clerk's relationship to patients, the health care team, the health care system, and self. Challenges with communication, the consent process, and breaking bad news were most commonly cited. Theme frequencies differed between junior and senior clerks. CONCLUSIONS Small group discussions of critical incident reports allow surgical clerks to reflect on their developing professional relationships. The themes that have been identified can be used to guide professionalism education and uncover the hidden curriculum.
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Koh GCH, Merchant RA, Lim WS, Amin Z. The Knowledge-Attitude Dissociation in Geriatric Education: Can It be Overcome? ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n9p383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: A knowledge-attitude dissociation often exists in geriatrics where knowledge but not attitudes towards elderly patients improve with education. This study aims to determine whether a holistic education programme incorporating multiple educational strategies such as early exposure, ageing simulation and small group teaching results in improving geriatrics knowledge and attitudes among medical students. Materials and Methods: We administered the 18-item University of California Los Angeles (UCLA) Geriatric Knowledge Test (GKT) and the Singapore-modified 16-item UCLA Geriatric Attitudes Test (GAT) to 2nd year students of the old curriculum in 2009 (baseline reference cohort, n = 254), and before and after the new module to students of the new curriculum in 2010 (intervention cohort, n = 261), both at the same time of the year. Results: At baseline, between the baseline reference and intervention cohort, there was no difference in knowledge (UCLA-GKT Score: 31.6 vs 33.5, P = 0.207) but attitudes of the intervention group were worse than the baseline reference group (UCLA-GAT Score: 3.53 vs 3.43, P = 0.003). The new module improved both the geriatric knowledge (UCLA-GKT Score: 34.0 vs 46.0, P<0.001) and attitudes (UCLA-GAT Score: 3.43 vs 3.50, P <0.001) of the intervention cohort. Conclusion: A geriatric education module incorporating sound educational strategies improved both geriatric knowledge and attitudes among medical students.
Key words: Asian medical school, Geriatrics attitudes, Geriatrics knowledge, Undergraduate medical student
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Affiliation(s)
- Gerald CH Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | | | | | - Zubair Amin
- National University Health System, Singapore
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Totic S, Stojiljkovic D, Pavlovic Z, Zaric N, Zarkovic B, Malic L, Mihaljevic M, Jasovic-Gasic M, Maric NP. Stigmatization of 'psychiatric label' by medical and non-medical students. Int J Soc Psychiatry 2012; 58:455-62. [PMID: 21719515 DOI: 10.1177/0020764011408542] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stigmatization of psychiatric patients is present both in the general population and among healthcare professionals. AIM To determine the attitudes and behaviour of medical students towards a person who goes to a psychiatrist, before and after psychiatric rotation, and to compare those attitudes between medical and non-medical students. METHODS The study included 525 medical students (second and sixth year of studies) and 154 students of law. The study instrument was a three-part self-reported questionnaire (socio-demographic data, Rosenberg Self-Esteem Scale and a vignette depicting a young, mentally healthy person). The experimental intervention consisted of ascribing a 'psychiatric label' to only one set of vignettes. All the vignettes (with or without the 'psychiatric label') were followed by 14 statements addressing the acceptance of a person described by vignette, as judged by social distance (four-point Likert scale). RESULTS Higher tendency to stigmatize was found in medical students in the final year, after psychiatric rotation (Z(U) = -3.12, p = .002), particularly in a closer relationship (Z(U) = -2.67, p = .007) between a student and a hypothetical person who goes to a psychiatrist. The non-medical students had a similar tendency to stigmatize as medical students before psychiatric rotation (Z(U) = -0.03, p = .975). Neither gender, nor the size of student's place of origin or average academic mark was associated with the tendency to stigmatize in our sample. However, student's elf-esteem was lower in those with a tendency to stigmatize more in a distant relationship (ρ = -0.157, p = .005). CONCLUSIONS Psychiatric education can either reinforce stigmatization or reduce it. Therefore, detailed analyses of educational domains that reinforce stigma will be the starting point for anti-stigma action.
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Affiliation(s)
- Sanja Totic
- Clinic of Psychiatry, Clinical Centre Serbia, Belgrade, Serbia
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134
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Power BT, Lennie SC. Pre-registration dietetic students' attitudes to learning communication skills. J Hum Nutr Diet 2012; 25:189-97. [PMID: 22330052 DOI: 10.1111/j.1365-277x.2012.01226.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Communication is a core skill and a prerequisite for dietitians' clinical competence. It is generally acknowledged that communication skills can be taught and learned. There is a paucity of published work identifying dietetic students' attitudes towards learning communication skills, and understanding this is important. METHODS The present cross-sectional study aimed to address this issue using an adapted version of the Communication Skills Attitude Scale (CSAS), which was designed to capture information concerning positive and negative attitudes to learning communication skills. An online questionnaire was sent to all undergraduate and post-graduate dietetic programmes in the UK. RESULTS Of the students' solicited for enrolment in the study, 33.4% (n = 300) completed the questionnaire. A one-way analysis of variance showed attitudes to learning communication skills differed significantly between years of study on both subscales of the CSAS. Subsequent analyses indicated that first-year students' attitudes to learning communication skills were significantly more positive than those of fourth-year students (P = 0.042). Third-year students had significantly more positive attitudes to learning communication skills than fourth-year students (P = 0.028). Negative attitudes were also linked to the year of study with fourth-year students having significantly more negative attitudes than third-year students (P = 0.046). Sex, practice placement experience and parental occupation did not significantly influence attitudes to learning communication skills. CONCLUSIONS These findings indicate that efforts are required to maintain positive attitudes to learning communication skills. Further longitudinal studies are recommended in this respect.
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Affiliation(s)
- B T Power
- School of Pharmacy and Life Sciences, Robert Gordon University, St Andrew Street, Aberdeen, UK
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Lahey T. Perspective: a proposed medical school curriculum to help students recognize and resolve ethical issues of global health outreach work. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:210-5. [PMID: 22189876 DOI: 10.1097/acm.0b013e31823f3fb1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Medical students' interest in global health outreach work is intense and growing. Yet, medical students' global health outreach work is fraught with ethical complexity: Students must make challenging resource allocation decisions in an unfamiliar setting while providing complicated care with evolving expertise across power gradients and geographical as well as cultural boundaries. Inadequate training in the recognition and resolution of the ethical issues inherent in this work likely endangers future service work participation and undercuts the efficacy of medical students' global health outreach work. The author describes how the medical school curriculum can empower medical students to recognize and resolve ethical issues encountered in global health outreach work. To achieve this goal, he proposes a curriculum in the ethics of global health outreach to train students to understand (1) the ethical justifications for global health outreach work, (2) the drivers of global health disparities, (3) the key ethical issues raised by global health outreach, and (4) how to resolve ethical quandaries encountered during global health outreach work through collaboration. Beyond specific topical content, a medical school curriculum in the ethics of global health outreach should emphasize the importance of local collaboration and longitudinal mentorship of medical students. Medical school training in the recognition and resolution of the ethical issues attendant on global health outreach work prepares students not only for more sophisticated work in international settings but also for the ethical complexities of medical practice closer to home.
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Affiliation(s)
- Timothy Lahey
- Dartmouth Medical School, Lebanon, New Hampshire 03756, USA.
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136
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Lunney CA, Kleinert HL, Ferguson JE, Campbell L. Effectively training pediatric residents to deliver diagnoses of Down syndrome. Am J Med Genet A 2012; 158A:384-90. [PMID: 22246816 DOI: 10.1002/ajmg.a.34422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 11/15/2011] [Indexed: 11/10/2022]
Abstract
Physicians and parents report a need for pediatricians to have additional training in delivering a diagnosis of Down syndrome (DS). This study tested a web-based tutorial to assess its effectiveness in improving physicians' perceived comfort with both ambiguous and more medically factual situations as they deliver diagnoses of DS. Based on this web tutorial that integrated prenatal and postnatal information into virtual patient scenarios, the study assessed pediatrics residents' knowledge and comfort in delivering a diagnosis of DS pre and postnatally. A separate survey, given at the same time, asked for residents' perception of their need for this training. Ninety-one volunteer residents from 10 pediatric training programs across the country participated. The tutorial yielded significant improvement in knowledge and a significant decrease in perceived level of discomfort in both ambiguous situations and more medically certain contexts related to a DS diagnosis. In addition, across all pediatric resident groups (by year, gender, and performance on the knowledge test and the comfort scale), residents strongly agreed that this type of training was beneficial for themselves, other residents, practicing physicians, and other medical professionals. This study suggests that web-based, interactive, multi-media training may be an effective tool for improving resident physician comfort with both ambiguous and more medically certain situations in delivering a diagnosis of DS to families.
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Affiliation(s)
- Carol A Lunney
- The Human Development Institute, University of Kentucky, Lexington, Kentucky, USA.
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137
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Bombeke K, Symons L, Vermeire E, Debaene L, Schol S, De Winter B, Van Royen P. Patient-centredness from education to practice: the 'lived' impact of communication skills training. MEDICAL TEACHER 2012; 34:e338-48. [PMID: 22452275 DOI: 10.3109/0142159x.2012.670320] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Although communication skills training (CST) enhances patient-centred skills and attitudes, the literature indicates a problematic transfer of these from education into practice. AIM We explored 'lived' experiences of medical students and doctors to gain a better understanding of the impact of CST on patient-centredness in the transition to real practice. METHODS From a phenomenological perspective, we conducted 15 interviews and 11 focus groups with 4-9 participants/group (n = 67) at two universities and carried out constant comparative analysis. RESULTS The gap between education and practice is the central phenomenon. Although CST raises students' communication awareness and self-efficacy in an 'ideal' context, this paradoxically seems to jeopardize their ability to bridge the gulf. In addition, CST does not come to grips with students' attitudes. However, CST appears to be successful in equipping students with long-lasting 'handles'. Yet students need more support to mould the provided 'ideal' models into their own unique style of context-specific patient-centred behaviour. This implies: raising students' awareness of own attitudes and communication styles, offering a more realistic training ground, integrating CST with clinical experience and translating the primary-care-rooted concept of patient-centredness into various specialization contexts. CONCLUSION CST could raise its impact by supporting students' recycling processes towards a personal style of context-sensitive patient-centredness.
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Affiliation(s)
- Katrien Bombeke
- Department of Primary and Interdisciplinary Care, University of Antwerp, Campus Drie Eiken, R3.11, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
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138
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Chan CMH, Ahmad WAW. Differences in physician attitudes towards patient-centredness: across four medical specialties. Int J Clin Pract 2012; 66:16-20. [PMID: 22171901 DOI: 10.1111/j.1742-1241.2011.02831.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS There is limited study on patient-centred attitudes with regards to the patient-physician relationship in physicians. The objective of this study was to examine and compare physician attitudes toward patient-centredness in four different medical settings. METHODS The present study utilised a cross-sectional survey design and purposive sampling to recruit physicians from a single academic medical centre via face-to-face interviews. Patient-centred attitudes of physicians specialising in surgery, oncology, obstetrics and gynaecology and primary care (N = 78) were compared on the Patient-Practitioner Orientation Scale (PPOS) using an independent one-way analysis of variance (ANOVA). The four medical specialties comprised the four levels, with role orientation (patient-centred orientation vs. doctor-centred orientation) as the dependent measure. RESULTS A significant level of difference (p < 0.001) was found between the four specialisations: oncologists were found to have the highest level of patient-centeredness, followed by obstetricians & gynaecologists and primary care physicians, with surgeons being the least patient-centred among specialisations sampled. CONCLUSION These data are the first from the South-East Asian region to demonstrate differences in physician attitudes between medical specialties. Our findings prompt further investigation and confirmation as to whether physicians with particular attitudinal traits are attracted to any particular specialties of medicine, or if physician attitudes are acquired through professional experience and training. In addition, this study offers better insight into the attitudinal differences of physician between medical specialities.
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Affiliation(s)
- C M H Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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139
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Augustine Egwu O, Dimkpa U, Ogbonnaya Orji J, Ogbannaya Njoku C, Ogbonnia Eni E, Besong E. Medical students - self-assessed confidence level before a major physiology examination: affective factors in a nigerian medical school. Acta Inform Med 2011; 19:153-7. [PMID: 23408661 PMCID: PMC3564182 DOI: 10.5455/aim.2011.19.153-157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 08/15/2011] [Indexed: 11/09/2022] Open
Abstract
Self-reported confidence before any examination in all levels of medical training is a product of previous experience, attitudinal inclinations overtime, degree of self subjection to tenets of professionalism and possibly, the inadvertent role of the medical school environment including colleagues, teachers and faculty members, comfort, satisfaction and psychosocial stability; which may be addressed as sub-factors that determine the level of preparedness. Let medical schools in Nigeria; adopt a continuous and regular assessment of students’ self confidence before any minor or major examination, to monitor and ensure a certain psychological and academic level of preparedness among the students. This will avoid some cases of attrition resulting from self-doubt and lack of preparedness.
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140
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Bombeke K, Van Roosbroeck S, De Winter B, Debaene L, Schol S, Van Hal G, Van Royen P. Medical students trained in communication skills show a decline in patient-centred attitudes: an observational study comparing two cohorts during clinical clerkships. PATIENT EDUCATION AND COUNSELING 2011; 84:310-8. [PMID: 21482064 DOI: 10.1016/j.pec.2011.03.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 03/05/2011] [Accepted: 03/07/2011] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Literature indicates a decline in patient-centredness in medical students, especially during clinical clerkships. We examined the impact of preclinical communication skills training (CST) on students' development of patient-centred attitudes and attitudes toward CST during clerkships. METHODS We prospectively compared two cohorts before and after clerkships: one cohort (n=48) had not received CST, whereas the other (n=37) had received a five-year CST. We assessed the impact using five validated questionnaires. RESULTS Communication trained students slightly but significantly declined in patient-centred attitudes (3/4 scales) and attitudes toward CST during clerkships, whereas the scores of the untrained students remained stable (5/5 scales). Both cohorts did not differ in attitudes before clerkships. In the trained cohort, males mostly showed a sharper decline than females. In the total group (n=85), females demonstrated higher attitude scores toward CST, and in 1/4 scales measuring patient-centred attitudes. CONCLUSION This cohort study suggests that CST might make students more vulnerable to decline in attitude scores during clerkships. PRACTICE IMPLICATIONS These remarkable findings, contrary to what educators would expect to result from their efforts, challenge medical education to address the new questions that are raised about the validity of the questionnaires, the impact of CST and the learning processes involved in the development of patient-centredness.
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Affiliation(s)
- Katrien Bombeke
- University of Antwerp, Department of Primary and Interdisciplinary Care, Wilrijk, Belgium.
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141
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Dyrbye LN, Schwartz A, Downing SM, Szydlo DW, Sloan JA, Shanafelt TD. Efficacy of a brief screening tool to identify medical students in distress. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:907-14. [PMID: 21642810 DOI: 10.1097/acm.0b013e31821da615] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE To determine whether the Medical Student Well-Being Index (MSWBI) can serve as a brief assessment tool to identify medical students in severe psychological distress. METHOD The authors used data from 2,248 medical students at seven U.S. medical schools who responded to a 2007 survey to explore the accuracy of the MSWBI in identifying medical students with three outcomes: low mental quality of life (QOL; defined by having a Medical Outcomes Study Short-Form Health Survey mental component summary score ≥1/2 standard deviation below that of the age- and gender-matched population norm), suicidal ideation, or serious thoughts of dropping out. The authors confirmed their analyses using data from a separate sample of 2,682 students evaluated in 2009. RESULTS Students with low mental QOL, suicidal ideation, or serious thoughts of dropping out were more likely to endorse each individual MSWBI item and a greater number of total items than were students without such distress (all P < .001). The likelihood ratio for low mental QOL among students with MSWBI scores <4 was 0.47 as compared with 4.79 for those with scores ≥4. At an MSWBI threshold score of ≥4, the MSWBI's sensitivity and specificity for identifying students with low mental QOL or recent suicidal ideation/serious thoughts of dropping out were both ≥90%. On multivariable logistic regression, all MSWBI items were independently associated with at least one outcome. CONCLUSIONS The MSWBI is a useful brief screening tool to help identify students with severe distress.
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Affiliation(s)
- Liselotte N Dyrbye
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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142
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Wayne S, Dellmore D, Serna L, Jerabek R, Timm C, Kalishman S. The association between intolerance of ambiguity and decline in medical students' attitudes toward the underserved. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:877-82. [PMID: 21617507 DOI: 10.1097/acm.0b013e31821dac01] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE Little published research details the risk factors for the decline in students' attitudes toward underserved populations during medical school. The authors assessed the association between this attitude change and intolerance of ambiguity (the tendency to perceive novel or complex situations as sources of threat), since treating underserved populations often involves a high level of complexity. METHOD The University of New Mexico School of Medicine administered a survey assessing attitudes toward underserved populations at matriculation and at graduation to seven consecutive medical school classes (matriculation years 1999 to 2005). The university also administered a survey measuring tolerance of ambiguity at matriculation. Five hundred twenty-nine students were eligible to complete both surveys between 1999 and 2009. RESULTS Three hundred thirteen (59%) students completed the attitude survey at matriculation and graduation. Attitude scores for a majority of students (69%) decreased from matriculation to graduation. Changes in scores ranged from +25 to -35; the average change was -4.5. Linear regression analysis showed that those who were tolerant of ambiguity (top 20% of tolerance of ambiguity scores) were significantly less likely to have declines in attitudes toward the underserved; the coefficient was 3.69 (P = .003). Other factors independently associated with maintaining high attitude scores were being female and starting medical school at age 24 or younger. CONCLUSIONS Attention to, and practice with, ambiguous situations may help moderate decreases in attitudes toward underserved populations. Medical education should address the fact that physicians face much ambiguity and should offer students tools to help them respond to ambiguous clinical situations.
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Affiliation(s)
- Sharon Wayne
- Office of Program Evaluation, Education, and Research, University of New Mexico School of Medicine, Albuquerque, 87131-0001, USA.
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143
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Joekes K, Noble LM, Kubacki AM, Potts HWW, Lloyd M. Does the inclusion of 'professional development' teaching improve medical students' communication skills? BMC MEDICAL EDUCATION 2011; 11:41. [PMID: 21708000 PMCID: PMC3141797 DOI: 10.1186/1472-6920-11-41] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 06/27/2011] [Indexed: 05/15/2023]
Abstract
BACKGROUND This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations. METHODS Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported. RESULTS Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination. CONCLUSIONS Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients.
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Affiliation(s)
- Katherine Joekes
- Division of Medical Education, UCL, Archway Campus, Highgate Hill, London, N19 5LW, UK
- Division of Population Health Sciences and Education, St George's, University of London, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| | - Lorraine M Noble
- Division of Medical Education, UCL, Archway Campus, Highgate Hill, London, N19 5LW, UK
| | - Angela M Kubacki
- Division of Medical Education, UCL, Archway Campus, Highgate Hill, London, N19 5LW, UK
- Division of Population Health Sciences and Education, St George's, University of London, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| | - Henry WW Potts
- Centre for Health Informatics and Multiprofessional Education, UCL, Archway Campus, Highgate Hill, London, N19 5LW, UK
| | - Margaret Lloyd
- Research Department of Primary Care and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Bazemore AW, Goldenhar LM, Lindsell CJ, Diller PM, Huntington MK. An International Health Track Is Associated With Care for Underserved US Populations in Subsequent Clinical Practice. J Grad Med Educ 2011; 3:130-7. [PMID: 22655132 PMCID: PMC3184923 DOI: 10.4300/jgme-d-10-00066.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/12/2010] [Accepted: 01/11/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recent efforts to increase insurance coverage have revealed limits in primary care capacity, in part due to physician maldistribution. Of interest to policymakers and educators is the impact of nontraditional curricula, including global health education, on eventual physician location. We sought to measure the association between graduate medical education in global health and subsequent care of the underserved in the United States. METHODS In 2005, we surveyed 137 graduates of a family medicine program with one of the country's longest-running international health tracks (IHTs). We compared graduates of the IHT, those in the traditional residency track, and graduates prior to IHT implementation, assessing the anticipated and actual involvement in care of rural and other underserved populations, physician characteristics, and practice location and practice population. RESULTS IHT participants were more likely to practice abroad and care for the underserved in the United States in the first 5 years following residency than non-IHT peers. Their current practices were more likely to be in underserved settings and they had higher percentages of uninsured and non-English-speaking patients. Comparisons between pre-IHT and post-IHT inception showed that in the first 5 years following residency, post-IHT graduates were more likely to care for the underserved and practice in rural areas and were likely to offer volunteer community health care services but were not more likely to practice abroad or to be in an academic practice. CONCLUSIONS Presence of an IHT was associated with increased care of underserved populations. After the institution of an IHT track, this association was seen among IHT participants and nonparticipants and was not associated with increased long-term service abroad.
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Li STT, Srinivasan M, Der-Martirosian C, Kravitz RL, Wilkes MS. Developing personal values: trainees' attitudes toward strikes by health care providers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:580-585. [PMID: 21436671 DOI: 10.1097/acm.0b013e318212b551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Worldwide, health care providers use strikes and job actions to influence policy. For health care providers, especially physicians, strikes create an ethical tension between an obligation to care for current patients (e.g., to provide care and avoid abandonment) and an obligation to better care for future patients by seeking system improvements (e.g., improvements in safety, to access, and in the composition and strength of the health care workforce). This tension is further intensified when the potential benefit of a strike involves professional self-interest and the potential risk involves patient harm or death. By definition, trainees are still forming their professional identities and values, including their opinions on fair wages, health policy, employee benefits, professionalism, and strikes. In this article, the authors explore these ethical tensions, beginning with a discussion of reactions to a potential 2005 nursing strike at the University of California, Davis, Medical Center. The authors then propose a conceptual model describing factors that may influence health care providers' decisions to strike (including personal ethics, personal agency, and strike-related context). In particular, the authors explore the relationship between training level and attitudes toward taking a job action, such as going on strike. Because trainees' attitudes toward strikes continue to evolve during training, the authors maintain that open discussion around the ethics of health care professionals' strikes and other methods of conflict resolution should be included in medical education to enhance professionalism and systems-based practice training. The authors include sample case vignettes to help initiate these important discussions.
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Affiliation(s)
- Su-Ting T Li
- Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California 95817, USA.
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Austad KE, Avorn J, Kesselheim AS. Medical students' exposure to and attitudes about the pharmaceutical industry: a systematic review. PLoS Med 2011; 8:e1001037. [PMID: 21629685 PMCID: PMC3101205 DOI: 10.1371/journal.pmed.1001037] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 04/15/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The relationship between health professionals and the pharmaceutical industry has become a source of controversy. Physicians' attitudes towards the industry can form early in their careers, but little is known about this key stage of development. METHODS AND FINDINGS We performed a systematic review reported according to PRISMA guidelines to determine the frequency and nature of medical students' exposure to the drug industry, as well as students' attitudes concerning pharmaceutical policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from the earliest available dates through May 2010, as well as bibliographies of selected studies. We sought original studies that reported quantitative or qualitative data about medical students' exposure to pharmaceutical marketing, their attitudes about marketing practices, relationships with industry, and related pharmaceutical policy issues. Studies were separated, where possible, into those that addressed preclinical versus clinical training, and were quality rated using a standard methodology. Thirty-two studies met inclusion criteria. We found that 40%-100% of medical students reported interacting with the pharmaceutical industry. A substantial proportion of students (13%-69%) were reported as believing that gifts from industry influence prescribing. Eight studies reported a correlation between frequency of contact and favorable attitudes toward industry interactions. Students were more approving of gifts to physicians or medical students than to government officials. Certain attitudes appeared to change during medical school, though a time trend was not performed; for example, clinical students (53%-71%) were more likely than preclinical students (29%-62%) to report that promotional information helps educate about new drugs. CONCLUSIONS Undergraduate medical education provides substantial contact with pharmaceutical marketing, and the extent of such contact is associated with positive attitudes about marketing and skepticism about negative implications of these interactions. These results support future research into the association between exposure and attitudes, as well as any modifiable factors that contribute to attitudinal changes during medical education. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Kirsten E. Austad
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
Massachusetts, United States of America
- Edmond J. Safra Center for Ethics at Harvard University, Cambridge,
Massachusetts, United States of America
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
Massachusetts, United States of America
| | - Aaron S. Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
Massachusetts, United States of America
- Edmond J. Safra Center for Ethics at Harvard University, Cambridge,
Massachusetts, United States of America
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147
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Hovey RB, Dvorak ML, Burton T, Worsham S, Padilla J, Hatlie MJ, Morck AC. Patient safety: a consumer's perspective. QUALITATIVE HEALTH RESEARCH 2011; 21:662-672. [PMID: 21343433 DOI: 10.1177/1049732311399779] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this article we provide a reconceptualization of patient-centered health care practice through a collaborative person-centered model for enhanced patient safety. Twenty-one participants were selected and interviewed from the internationally diverse population of individuals attending the Chicago Patient Safety Workshop (CPSW) sponsored by Consumers Advancing Patient Safety (CAPS). Analysis of the participant transcripts revealed three findings related to patient experience: the impact and meaning of communication and relationship within the health care setting, trust and expectation for the patient and family with the health care provider, and the meaning and application of patient-centeredness. Researchers concluded that successful planning toward enhanced patient-centered care requires multiple perspectives, including the voices of the patient and family members who have experienced the trauma of preventable medical error. Collaborative initiatives such as the CPSW and CAPS offer a positive way forward for enhanced patient safety and quality of care.
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148
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Ghodasara SL, Davidson MA, Reich MS, Savoie CV, Rodgers SM. Assessing student mental health at the Vanderbilt University School of Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:116-21. [PMID: 21099385 DOI: 10.1097/acm.0b013e3181ffb056] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To determine the prevalence rates of four major categories of mental illness among medical students and to examine associations between these illnesses and a range of demographic variables. METHOD The authors invited all 330 first-, second-, and third-year medical students at Vanderbilt University School of Medicine to participate in a survey during winter 2008-2009. Students completed an anonymous written questionnaire assessing the prevalence of depression, anxiety, eating disorders, and alcohol and drug use disorders. Additionally, the authors obtained student demographic information to investigate variations in rates of illness based on interindividual differences. RESULTS Most students (301; response rate: 91.2%) completed the survey. The authors found that depression and anxiety were more prevalent in the Vanderbilt medical student population than in their nonmedical peer group. The authors found that 37 (12%) of the students were borderline for possible alcohol abuse and 3 (1%) were problem drinkers, 1 (0.3%) had a possible drug abuse disorder, and 3 (1%) had possible eating disorders. Whereas exercising one to three times per week was associated with lower rates of both depression and anxiety, having a family history of mental illness was associated with higher eating disorder scores and anxiety. There was an association between gender and all disorders. CONCLUSIONS Insight into the prevalence of mental health disorders in the medical student population and the variables that may influence them provides important information for medical schools as they develop more robust and effective wellness programs to help students in these very stressful learning environments.
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Hazel SJ, Signal TD, Taylor N. Can teaching veterinary and animal-science students about animal welfare affect their attitude toward animals and human-related empathy? JOURNAL OF VETERINARY MEDICAL EDUCATION 2011; 38:74-83. [PMID: 21805938 DOI: 10.3138/jvme.38.1.74] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Attitudes toward animals are important in influencing how animals are treated. Few studies have investigated attitudes toward animals in veterinary or animal-science students, and no studies have compared attitudes to animals before and after a course teaching animal welfare and ethics. In this study, students enrolled in veterinary (first-year) or animal-science (first- and third-year) programs completed a questionnaire on attitudes toward different categories of animals before and after the course. Higher attitude scores suggest a person more concerned about how an animal is treated. Normally distributed data were compared using parametric statistics, and non-normally distributed data were compared using non-parametric tests, with significance p < .05. Attitudes toward pets (45.5-47.6) were higher than those toward pests (34.2-38.4) or profit animals (30.3-32.1). Attitude scores increased from before to after the course in the veterinary cohort on the Pest (36.9 vs. 38.4, respectively, n = 27, p < .05) and Profit (30.3 vs. 32.1, respectively, n = 28, p < .05) subscales, but not in the animal-science cohorts. Attitude scores in all categories were higher for women than for men. Currently having an animal was associated with higher pet scores (46.8 vs. 43.8, ns = 120 and 13, respectively, p < .05), and having an animal as a child was associated with higher profit scores (31.0 vs. 26.6, ns = 129 and 8, respectively, p < .05). Students electing to work with livestock had lower scores on the Pest and Profit subscales, and students wanting to work with wildlife had significantly higher scores on the Pest and Profit subscales. This study demonstrates attitudinal changes after an animal-welfare course, with significant increases in veterinary but not animal-science students.
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Affiliation(s)
- Susan J Hazel
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy, Australia.
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Baingana RK, Nakasujja N, Galukande M, Omona K, Mafigiri DK, Sewankambo NK. Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students. BMC MEDICAL EDUCATION 2010; 10:76. [PMID: 21050457 PMCID: PMC2987936 DOI: 10.1186/1472-6920-10-76] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 11/04/2010] [Indexed: 05/10/2023]
Abstract
BACKGROUND Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda. METHODS Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding. RESULTS The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism. CONCLUSIONS The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.
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Affiliation(s)
- Rhona K Baingana
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Noeline Nakasujja
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Moses Galukande
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Kenneth Omona
- Lira Regional Referral Hospital, P. O. Box 2, Lira, Uganda
| | - David K Mafigiri
- Faculty of Social Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Nelson K Sewankambo
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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