Personal life events and medical student burnout: a multicenter study

Application of an interpersonal-psychological model of suicidal behavior to physicians and medical trainees

Physicians and medical trainees (medical students and residents) are at increased risk for suicidal ideation. Yet few conceptual models have attempted to explain the elevated rates of suicide among physicians, and very little is known about what factors contribute to medical trainees' suicidal ideation and behaviors. In this paper, Joiner's (2005) interpersonal-psychological theory of suicidality will be explored as it applies to suicidal ideation and behavior among physicians and medical trainees. Literature addressing each component of the theory will be reviewed. Drawing upon extant data, each dimension of the theory (burden, thwarted belongingness, and acquired ability) will be examined in depth in terms of its applicability to suicidal thinking and behavior among physicians and physicians-in-training. Findings from the literature provide support for the interpersonal-psychological theory of suicidality as applied to this population.

The characteristics of depressive symptoms in medical students during medical education and training: a cross-sectional study

BACKGROUND

Medical education and training can contribute to the development of depressive symptoms that might lead to possible academic and professional consequences. We aimed to investigate the characteristics of depressive symptoms among 481 medical students (79.8% of the total who matriculated).

METHODS

The Beck Depression Inventory (BDI) and cluster analyses were used in order to better describe the characteristics of depressive symptoms. Medical education and training in Brazil is divided into basic (1st and 2nd years), intermediate (3rd and 4th years), and internship (5th and 6th years) periods. The study organized each item from the BDI into the following three clusters: affective, cognitive, and somatic. Statistical analyses were performed using analysis of variance (ANOVA) with post-hoc Tukey corrected for multiple comparisons.

RESULTS

There were 184 (38.2%) students with depressive symptoms (BDI > 9). The internship period resulted in the highest BDI scores in comparison to both the basic (p < .001) and intermediate (p < .001) periods. Affective, cognitive, and somatic clusters were significantly higher in the internship period. An exploratory analysis of possible risk factors showed that females (p = .020) not having a parent who practiced medicine (p = .016), and the internship period (p = .001) were factors for the development of depressive symptoms.

CONCLUSION

There is a high prevalence towards depressive symptoms among medical students, particularly females, in the internship level, mainly involving the somatic and affective clusters, and not having a parent who practiced medicine. The active assessment of these students in evaluating their depressive symptoms is important in order to prevent the development of co-morbidities and suicide risk.

Development of an instrument to measure the climate of professionalism in a clinical teaching environment

BACKGROUND

This report describes an instrument that measures professionalism in clinical environments, reports its psychometric properties, and discusses its potential uses.

METHOD

The survey asked students (n = 371) to report the frequency of peers', residents', and faculty's professionalism behaviors and faculty's professionalism teaching, and it asked faculty (n = 28) to self-assess their teaching of professionalism. The authors investigated the instrument's reliability, convergent validity, and ability to detect differences between groups.

RESULTS

Coefficient alphas were .75 or higher. Correlations showed positive relationships between students' perceptions of professionalism behaviors and faculty's professionalism teaching. t-tests indicated that preclinical students rated faculty's professionalism behaviors higher than did clinical students, and students rated faculty's professionalism teaching higher than the faculty rated themselves.

CONCLUSIONS

The psychometrics of the instrument's scores are sound. The instrument has potential to meet the Liaison Committee on Medical Education's mandate to measure professional standards within learning environments and to track effects of interventions promoting the professionalism of learners and faculty.

Mental health treatment needs for medical students: a national longitudinal study

Purpose

We aimed to study the occurrence and predictors of medical students' mental health problems that required treatment.

Subjects and methods

Medical students from all Norwegian universities (N = 421) were surveyed in their first term (T1), and 3 (T2) and 6 (T3) years later. The dependent variable was “Mental health problems in need of treatment”. Predictor variables included personality traits, medical school stress and negative life events.

Results

The lifetime prevalence of mental health problems was 15% at T1. At T2, of the 31% who reported problems during the first 3 years, a majority had not sought help. At T3, 14% reported problems during the preceding year. Adjusted predictors of problems at T2 were previous mental health problems (p < .001), low level of intensity personality trait (extraversion) (p < .01), reality weakness personality trait (p < .01), perceived medical school stress (p < .05) and negative life events (p < .05).

Discussion

Mental health problems during the first 3 years were predicted by previous problems, personality, medical school stress and negative life events.

Conclusion

A third of the students reported mental health problems during the first 3 years. Intervention should focus on both individual problems and contextual stress.

Evolving trends in balancing work and family for future academic physicians: a role for personal stories

Overlapping trends in medicine include, (1) an increasing number of women entering medicine, (2) a growing number of generation X physicians, (3) the implementation of duty hour regulations, and (4) a diversifying workforce which have all contributed to the need for mentoring learners and young faculty in the area of balancing work and family. In pace with the increasing complexity of their lives and practices, women trainees and young physicians are seeking creative solutions to the challenges of simultaneous work and parenting. As teachers and mentors in academic medicine, it is our calling to share our own personal stories about personal and professional balance to help attract, retain, and anchor the next generation of physicians and identify policies in need of change.

A career in surgical oncology: finding meaning, balance, and personal satisfaction

The practice of surgical oncology provides opportunities for both personal distress as well as personal satisfaction. While many surgical oncologists experience career burnout, others derive great meaning and satisfaction from their work. In this article, we review the literature on surgeon burnout, discuss potential personal and professional consequences, and consider steps individual surgeons can take to promote personal and professional satisfaction.

The Association Between Parental Socioeconomic Status (SES) and Medical Students’ Personal and Professional Development

Introduction: In order to commit to their mission and placement requirements, medical education policy-makers are required to understand the background and character of students in order to admit, cultivate and support them efficiently and effectively. Materials and Methods: This study sample consisted of 408 homogeneous medical students with the same level of education, occupation, school and societal environment. They differed mainly in their family background. Therefore, this study used part of a multidimensional “student portfolio system” database to assess the correlation between family status (indexed by parental education and occupation) and medical students’ mental health status and characters. The controls were a group of 181 non-medical students in another university. Results: The parents of the medical students were from a higher socioeconomic status (SES) than the parents of those in the control group. This showed the heritability of genetic and environment conditions as well as the socioeconomic forces at play in medical education. Students’ personal and professional development were associated with their parents’ SES. The mother’s SES was associated with the student’s selfreported stress, mental disturbances, attitude towards life, personality, health, discipline, internationalisation and professionalism. The fathers’ SES did not show a statistically significant association with the above stress, physical and mental health factors, but showed an association with some of the personality factors. The greater the educational difference between both parents, the more stress, hopelessness and pessimism the student manifested. Conclusions: Medical educators need to be aware that socioeconomic factors have meaningful patterns of association with students’ mental and physical health, and their characters relating to personal and professional development. Low maternal SES negatively influences medical students’ personal and professional development, suggesting that medical education policy-makers need to initiate support mechanisms for those with latent vulnerability. Key words: Risk factors, Stress

Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study

BACKGROUND

Mental distress among medical students is often reported. Burnout has not been studied frequently and studies using interviewer-rated diagnoses as outcomes are rarely employed. The objective of this prospective study of medical students was to examine clinically significant psychiatric morbidity and burnout at 3rd year of medical school, considering personality and study conditions measured at 1st year.

METHODS

Questionnaires were sent to 127 first year medical students who were then followed-up at 3rd year of medical school. Eighty-one of 3rd year respondents participated in a diagnostic interview. Personality (HP5-i) and Performance-based self-esteem (PBSE-scale) were assessed at first year, Study conditions (HESI), Burnout (OLBI), Depression (MDI) at 1st and 3rd years. Diagnostic interviews (MINI) were used at 3rd year to assess psychiatric morbidity. High and low burnout at 3rd year was defined by cluster analysis. Logistic regressions were used to identify predictors of high burnout and psychiatric morbidity, controlling for gender.

RESULTS

98 (77%) responded on both occasions, 80 (63%) of these were interviewed. High burnout was predicted by Impulsivity trait, Depressive symptoms at 1st year and Financial concerns at 1st year. When controlling for 3rd year study conditions, Impulsivity and concurrent Workload remained. Of the interviewed sample 21 (27%) had a psychiatric diagnosis, 6 of whom had sought help. Unadjusted analyses showed that psychiatric morbidity was predicted by high Performance-based self-esteem, Disengagement and Depression at 1st year, only the later remained significant in the adjusted analysis.

CONCLUSION

Psychiatric morbidity is common in medical students but few seek help. Burnout has individual as well as environmental explanations and to avoid it, organisational as well as individual interventions may be needed. Early signs of depressive symptoms in medical students may be important to address. Students should be encouraged to seek help and adequate facilities should be available.

How do distress and well-being relate to medical student empathy? A multicenter study

OBJECTIVE

To determine whether lower levels of empathy among a sample of medical students in the United States are associated with personal and professional distress and to explore whether a high degree of personal well-being is associated with higher levels of empathy.

DESIGN

Multi-institutional, cross-sectional survey.

SETTING

All medical schools in Minnesota (a private medical school, a traditional public university, and a public university with a focus in primary care).

PARTICIPANTS

A total of 1,098 medical students.

MEASUREMENTS

Validated instruments were used to measure empathy, distress (i.e., burnout and symptoms of depression), and well-being (high quality of life).

RESULTS

Medical student empathy scores were higher than normative samples of similarly aged individuals and were similar to other medical student samples. Domains of burnout inversely correlated with empathy (depersonalization with empathy independent of gender, all P < .02, and emotional exhaustion with emotive empathy for men, P = .009). Symptoms of depression inversely correlated with empathy for women (all P < or = .01). In contrast, students' sense of personal accomplishment demonstrated a positive correlation with empathy independent of gender (all P < .001). Similarly, achieving a high quality of life in specific domains correlated with higher empathy scores (P < .05). On multivariate analysis evaluating measures of distress and well-being simultaneously, both burnout (negative correlation) and well-being (positive correlation) independently correlated with student empathy scores.

CONCLUSIONS

Both distress and well-being are related to medical student empathy. Efforts to reduce student distress should be part of broader efforts to promote student well-being, which may enhance aspects of professionalism. Additional studies of student well-being and its potential influence on professionalism are needed.

Performance-based self-esteem and burnout in a cross-sectional study of medical students

OBJECTIVES

To examine levels of burnout among medical students and test the hypothesis that high performance-based self-esteem is associated with burnout. Further to study associations between burnout and self-rated health.

DESIGN

Cross-sectional survey, of medical students at 1st, 3rd and 6th year of medical school, N = 342, 59.1% women.

MEASURES

Burnout was monitored by the Oldenburg Burnout Inventory (OLBI), comprising Exhaustion and Disengagement dimensions. Performance-based self-esteem (PBSE) was assessed by the PBSE-scale (PBSS) and self-rated health by SRH-5.

RESULTS

The response rate was 90.4%. Females were more exhausted than males and sixth year students were most disengaged. High performance-based self-esteem was present in 41.7% of the respondents and poor health in 10.7%. Performance-based self-esteem had significant and moderate correlations with both burnout dimensions. Logistic regression showed a positive association between poor health and Exhaustion.

CONCLUSIONS

Exhaustion among medical students was significantly associated with poor health, and deserves attention from teachers. Performance-based self-esteem was higher than in other populations and associated with both burnout dimensions, but not with poor health. Further research on study environment and burnout is needed, and the reasons for female students' higher exhaustion levels should be further investigated.

Common mental disorders among medical students

OBJECTIVE: Common mental disorders (CMD) have a high impact on interpersonal relationships and quality of life and are potential underlying causes for the development of more serious disorders. Medical students have been indicated as a risk population for the development of CMD. The aim of this study was to determine the frequency of CMD in undergraduate medical students and to identify related factors. METHODS: A cross-sectional study was performed in a sample population of medical students. CMD was identified according to the 20-item Self-Report Questionnaire. RESULTS: Two hundred and twenty-three students completed the questionnaire. The overall prevalence of CMD was 29.6% and its presence was independently associated with sleep disorders, not owning a car, not working and sedentary lifestyle. CONCLUSIONS: These findings indicate a high prevalence of CMD in the sample studied and are important for supporting actions to prevent mental disorders in future doctors and for reflecting on the curricula currently in use in medical schools.

A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students

OBJECTIVE

To determine the well-being of minority medical students in a multicenter sample of US medical students.

PARTICIPANTS AND METHODS

All 1098 medical students at 3 medical schools in Minnesota were surveyed in April 2004. Validated instruments were used to assess burnout, depression, and quality of life (QOL). Students were also asked about the prevalence of significant personal life events in the previous 12 months and strategies used to cope with stress.

RESULTS

Although symptoms of depression and overall burnout were similar among minority and nonminority students, minority students were more likely to have a low sense of personal accomplishment (P=.02) and lower QOL In a number of domains (all P< or =.05). These differences persisted on multivariate analysis that controlled for demographic characteristics and recent life events. Minority students were also more likely to have a child (P=.01), originate from outside Minnesota (P<.001), and experience a major personal Illness in the last 12 months (P=.03).

CONCLUSION

As a group, the minority medical students in this survey had a lower sense of personal accomplishment and QOL than nonminority students. Additional studies are needed to provide insight regarding the causes of these inequities and the unique challenges faced by minority medical students. Efforts to improve minority students' well-being, QOL, and learning experience may help prevent attrition among minority medical students and promote diversification in the physician workforce.