The anxieties of medical students related to clinical training

Optimizing Individual Wound Closure Practice Using Augmented Reality: A Randomized Controlled Study

Background Suturing requires repeated practice with guidance to prevent skill deterioration; however, guidance is often limited by expert availability. There is evidence that augmented reality (AR) may assist procedural skill acquisition among learners. This study examines the use of an AR suture guidance application to assist the independent practice of suturing. Methodology A novel suture guidance application was designed for the Microsoft HoloLens. The guidance system included a calibration system and holograms that projected over a suture pad in a stepwise manner. To assess the application, 30 medical students were recruited and randomly assigned to two groups. The control group (n = 16) was given 30 minutes of independent suture practice, while the experimental group (n = 14) utilized the suture guidance application. Both groups completed a pre- and post-test wound closure assessment. After the post-test, the control group trialed the suture guidance application. All participants completed a feedback survey on the application. Statistical analysis was completed using Stata (StataCorp., College Station, TX, USA) with paired Student's t-tests and Welch's t-tests with a significance of 95%. Results Both groups demonstrated a significant improvement in total time and time per stitch during the post-test. Additionally, comparing pre- and post-test assessments in the experimental group revealed a significant improvement in the total number of stitches (p = 0.007), the ratio of bisecting stitches (p = 0.02), and the symmetry of stitch bite (p = 0.03). The feedback survey supported the application for guiding suture placement and spacing. Participants identified limitations in the hologram stability and neck positioning. Conclusions This study suggests the potential to use AR to facilitate the independent practice of wound closure within simulation environments.

The use of virtual patients for breaking bad news: A rapid review

BACKGROUND

Breaking bad news is an imperative skill for clinical practice that health care professionals struggle with. Virtual patients have been adopted as a new teaching aide in medical education and have shown efficacy in teaching clinical skills; however, there is limited research for use in communication skills. Virtual patients are especially well-suited for difficult communication skills, as students can practice without risk to patients. This rapid review aimed to review literature observing the potential of virtual patients as an effective means to teach breaking bad news.

METHOD

A systematic search strategy was applied for papers published between November 2012 and November 2022 on Medline and Embase databases. Following the application of inclusion criteria, three studies were included. The Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme checklist were used for quality appraisal of the studies. Tabular and narrative synthesis was used to present the findings.

FINDINGS

The findings of the studies suggest that when teaching breaking bad news, virtual patients are valuable compared with no intervention and are not inferior compared with simulated patients. An unexpected benefit of virtual patients was videotaping. A barrier to learning was the lack of affect and interaction. More research into the design of virtual simulations and its integration into existing curricula is required.

CONCLUSION

Virtual patients are a valuable educational tool for breaking bad news; however, they are yet to replace existing educational approaches. There is a need for more large-scale, homogeneous studies to inform instructional design and curriculum integration.

Watch vs do: A randomized crossover design evaluating modified simulated patients and video learning for novice speech-language therapy students

BACKGROUND

Simulated learning activities are an effective tool for reducing speech-language therapy (SLT) students' anxiety and improving their confidence for clinical placements. Such activities include interacting with patients who are actors, clinical educators or peers and are known to decrease anxiety and increase confidence in SLT students. Screen-simulated patients using video are another alternative, which has not yet been fully evaluated in the education of SLT students.

AIMS

To compare the effectiveness of (1) modified simulated patient and (2) video simulated learning for increasing self-reported (a) confidence and (b) preparedness and (c) decreasing self-reported anxiety.

METHODS & PROCEDURES

This study used a randomized crossover design with 127 first-year graduate-entry master's SLT student participants. Students participated in two activities related to a clinical interaction with a paediatric client's carer: (1) a 1-hr modified simulated patient experience with clinical staff as the simulated patient; and (2) a video-learning task, with two videos of a clinician-carer interaction and an accompanying worksheet. Students were randomly allocated to a group of four students and the groups randomly allocated to receive modified simulated patient or video-learning first. Students were not blinded to the activities. The students completed a 19-item questionnaire at three time points: before either activity, after the first activity and after the second activity, to evaluate their self-reported confidence, clinical preparedness and anxiety.

OUTCOMES & RESULTS

A total of 62 students completed modified simulated patient first and 63 completed video-learning first. After either single activity the students had significantly increased confidence and preparedness scores, while only the modified simulated patient significantly reduced student anxiety scores. As a second activity, modified simulated patient resulted in further significant improvements in confidence, preparedness and anxiety; however, adding video learning as a second activity resulted in no significant benefit.

CONCLUSIONS & IMPLICATIONS

This study demonstrates the effectiveness of two low-resource clinical-learning activities for novice SLT students that can be applied in a range of settings. Of the two activities, modified simulated patient had greater effectiveness, as it was the only activity to decrease anxiety. An investigation of the pedagogical principles within the activities revealed that modified simulated patient activity had more opportunities for peer learning, supervisor feedback and verbal reflection in comparison with video learning that may explain the increased benefits.

WHAT THIS PAPER ADDS

What is already known on the subject Simulated learning activities are an effective teaching tool for SLT students, increasing confidence and decreasing anxiety in preparation for placement. Simulated patients require more resources than video simulation. Both simulated patients and video simulation provide a safe learning environment, where students can learn without risk to clients. What this paper adds to existing knowledge This study is among the first to investigate a modified version of simulated patients; our modification involves a clinical educator performing the role of both the simulated patient and simulation facilitator. It is the first to evaluate simulation via video learning for SLT students. The paper demonstrates the effectiveness of these two activities, and the slight advantage of modified simulated patient, for increasing novice students' confidence and preparedness and decreasing their anxiety about clinic. It also unpacks the pedagogical principles used in each activity to explain the reasons that modified simulated patient had greater effectiveness. What are the potential or actual clinical implications of this work? The two educational activities required no specialist equipment and can be applied in a range of pre-clinical and clinical settings by university staff and/or community clinical educators. Increasing confidence and preparedness, and decreasing anxiety will help ensure that student learning on scarce clinical placements is maximized.

How Medical Students Apply Their Biomedical Science Knowledge to Patient Care in the Family Medicine Clerkship

Medical students enter clerkships with the requisite biomedical science knowledge to engage in supervised patient care. While poised to apply this knowledge, students face the cognitive challenge of transfer: applying knowledge learned in one context (i.e., preclinical classroom) to solve problems in a different context (i.e., patients in the clinic). To help students navigate this challenge, a structured reflection exercise was developed using Kolb's experiential learning cycle as an organizing framework. Students selected a patient encounter (concrete experience), wrote and addressed biomedical science learning objectives related to the care of the patient (reflective observation), reflected on how addressing the learning objectives influenced patient care (abstract conceptualization), and described their attending engaging in a similar process (active experimentation). A directed content analysis of students' written reflections revealed that most students wrote clinical science learning objectives in addition to biomedical science learning objectives. When viewed through the lenses of knowledge encapsulation theory and illness script theory, some students recognized knowledge encapsulation as a process beginning to occur in their own approach and their attendings' approach to clinical reasoning. Students readily applied their biomedical science knowledge to explain the pathophysiologic basis of disease (fault illness script domain) and signs and symptoms (consequence illness script domain), with fewer addressing predisposing conditions (enabling conditions illness script domain). Instances in which students observed their attending applying biomedical science knowledge were rare. Implications for using structured reflective writing as a tool to facilitate student application of their biomedical science knowledge in clerkships are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01697-5.

Deconstructing forearm casting task by videos with step-by-step simulation teaching improved performance of medical students: is making working student's memory work better similar to a process of artificial intelligence or just an improvement of the prefrontal cortex homunculus?

PURPOSE

To compare two teaching methods of a forearm cast in medical students through simulation, the traditional method (Trad) based on a continuous demonstration of the procedure and the task deconstruction method (Decon) with the procedure fragmenting into its constituent parts using videos.

METHODS

During simulation training of the below elbow casting technique, 64 medical students were randomized in two groups. Trad group demonstrated the entire procedure without pausing. Decon group received step-wise teaching with educational videos emphasizing key components of the procedure. Direct and video evaluations were performed immediately after training (day 0) and at six months. Performance in casting was assessed using a 25-item checklist, a seven item global rating scale (GRS Performance), and a one item GRS (GRS Final Product).

RESULTS

Fifty-two students (Trad n = 24; Decon n = 28) underwent both day zero and six month assessments. At day zero, the Decon group showed higher performance via video evaluation for OSATS (p = 0.035); GRS performance (p < 0.001); GRS final product (p < 0.001), and for GRS performance (p < 0.001) and GRS final product (p = 0.011) via direct evaluation. After six months, performance was decreased in both groups with ultimately no difference in performance between groups via both direct and video evaluation. Having done a rotation in orthopaedic surgery was the only independent factor associated to higher performance.

CONCLUSIONS

The modified video-based version simulation led to a higher performance than the traditional method immediately after the course and could be the preferred method for teaching complex skills.

Reflection on near-peer shadowing program: impact on operating room student's perception of their future profession

BACKGROUND

Reflection is a key element in learning from observation and experience of future profession's roles and responsibilities in clinical encounters. Moreover, reflection helps students cope with the challenges, complexities, and uncertainties of professional development. Students' written reflections on clinical exposure offer valuable information, and their analysis provides instructors with invaluable insight into students' experiences. This study evaluated Operating Room students' written reflections on their first clinical exposure experiences towards their future profession through the shadowing program.

METHODS

This study was a qualitative analysis on Operating Room freshmen's reflections in the undergraduate program of Zahedan and Zabol University of Medical Sciences in Iran. After the shadowing program, all participants were asked to write an unstructured written reflection, and these fifty written reflections were de-identified and independently analyzed‏ using the thematic analysis approach.

RESULTS

Qualitative analysis extracted 10 subthemes and four main themes including (i) Moving towards the guiding realities of future profession, (ii) Discovering milestones of realizing professional identity, (iii) Managing the emotions affecting the perception of future profession's desirability, and (iv) Excellence in professional growth and development.

CONCLUSION

Reflecting on the experience of the shadowing program, the participants described being in the OR environment as a stimulating and valuable learning opportunity. Moreover, this experience helped improve their perception of future profession's realities, as well as initiate realization of professional identity and planning for professional developments.

Stakeholder perspectives on veterinary student preparedness for workplace clinical training – a qualitative study

Background

The success of workplace clinical training (WCT) is important given that veterinary students are licensed to work independently upon graduation. Considering this, it is perhaps surprising that there is limited published work describing what it means to be prepared for this educational experience, particularly given that the transition to WCT can be stressful for students. This paper reports the results of a qualitative study aiming to generate a rich understanding of veterinary student preparedness for WCT using emic, or insider, perspectives of key stakeholders.

Methods

From a constructivist standpoint, homogenous online group interviews were held with final year veterinary students, recent student alumni, clinical supervisors, faculty, and academic educationalists to discuss what it means to be prepared for WCT. The data was analysed using a template analysis approach.

Results

A three-tier taxonomy to describe preparedness for WCT was constructed from the data. At the topmost level, there were seven themes to illuminate different aspects of preparedness: students should be prepared 1) for the transition to learning and working in a clinical and professional environment, 2) for self-directed and experiential learning whilst working, 3) with a growth mindset, 4) with intrinsic motivation and enthusiasm for learning and working, 5) for communication, consultation and clinical reasoning, 6) with the knowledge for work, and 7) with the practical competence and confidence for work.

Conclusions

This study provides a deeper understanding of the tools we can provide, and the attributes we can nurture in, senior veterinary students to facilitate their learning and working during WCT. This improved understanding is a necessary precursor to refining pedagogical support and curriculum design within veterinary schools.

Exploration the role of a clinical supervisor to improve the professional skills of medical students: a content analysis study

BACKGROUND AND PURPOSE

Clinical supervision supports learners and paves the way for effective and efficient learning in clinical settings. This study aimed to explain the responsibilities of clinical supervisors in clinical education wards to improve the professional skills of medical students.

MATERIALS AND METHODS

In this qualitative study, we used the conventional content analysis approach. The sample consisted of 16 faculty members of medical sciences and medical graduates of Iranian universities. Purposeful sampling and semi-structured interviews were used to collect data. The Graneheim and Lundman method (2004) analyzed the data.

RESULTS

From the analysis of interviews, 2 themes, 8 categories, and 18 subcategories were obtained. "Clinical supervisor responsibilities" as a theme includes the categories: "Creating motivation in learner", "Learner's need recognition", "Performance evaluation", "Creating learning opportunities", and "Professional ethics education". And, the sub-categories were: "Creating a supportive atmosphere", "Task assignment","Understanding training needs", "Understanding individual needs", "Periodic evaluation", "Proper feedback', "Reduce work stress", "Learner engagement' , "Learning Facilitation", "Attention to the patient's treatment", and "Ethical observance in relation to patients". As the second theme "Clinical supervisor characteristics" included the categories of: "Scientific competence", "Leading role", and "Ethical model". Their sub-categories are clustered as: "Knowledge of educational concepts", "Mastery of professional concepts", "Effective communication skills", "Understanding managerial concepts", "High resilience", "Career commitment ", and "social commitment" .

CONCLUSIONS

The clinical supervisor will improve the professional skills of medical students, which will improve the quality of services provided, train efficient graduates, and provide a safe and relaxing environment that leads to patient satisfaction.

RE-AIMing COVID-19 online learning for medical students: a massive open online course evaluation

BACKGROUND

Clinical training during the COVID-19 pandemic is high risk for medical students. Medical schools in low- and middle-income countries (LMIC) have limited capacity to develop resources in the face of rapidly developing health emergencies. Here, a free Massive Open Online Course (MOOC) was developed as a COVID-19 resource for medical students working in these settings, and its effectiveness was evaluated.

METHODS

The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was utilized to evaluate the effectiveness of MOOC in teaching medical students about COVID-19. The data sources included the student registration forms, metrics quantifying their interactions within the modules, students' course feedback, and free-text responses. The data were collected from the Moodle learning management system and Google analytics from May 9 to September 15, 2020. The research team analyzed the quantitative data descriptively and the qualitative data thematically.

RESULTS

Among the 16,237 unique visitors who accessed the course, only 6031 medical students from 71 medical schools registered, and about 4993 (83% of registrants) completed the course, indicating high levels of satisfaction (M = 8.17, SD = 1.49) on a 10-point scale. The mean scores of each assessment modules were > 90%. The free-text responses from 987 unique students revealed a total of 17 themes (e.g., knowing the general information on COVID-19, process management of the pandemic in public health, online platform use, and instructional design) across the elements of the RE-AIM framework. Mainly, the students characterized the MOOC as well-organized and effective.

CONCLUSIONS

Medical students learned about COVID-19 using a self-paced and unmonitored MOOC. MOOCs could play a vital role in the dissemination of accurate information to medical students in LMIC in future public health emergencies. The students were interested in using similar MOOCs in the future.

Effects of high-fidelity simulation education on medical students' anxiety and confidence

INTRODUCTION

Psychological factors such as anxiety and confidence that students have in the patient care situation are important in that this affects the actual clinical performance. Students who are just starting clinical practice have a lack of clinical knowledge, skill proficiency, and patient communication skills, so they experience anxiety and lack of confidence in clinical setting. Practice in a safe environment, such as simulation education, can help students perform more settled and competently in patient care. The purpose of this study was to analyze the effect of high-fidelity simulation experience on anxiety and confidence in medical students.

MATERIALS AND METHODS

This study enrolled 37 5th-year students at Ajou University School of Medicine in 2020. Two simulation trainings were implemented, and a survey was conducted to measure students' level of anxiety and confidence before and after each simulation. Based on the research data, a paired t-test was conducted to compare these variables before and after the simulation, and whether this was their first or second simulation experience.

RESULTS

Students had a significantly lower level of anxiety and a significantly higher level of confidence after the simulation than before. In addition, after one simulation experience, students had less anxiety and more confidence before the second simulation compared to those without simulation experience.

CONCLUSIONS

We confirmed that medical students need to be repeatedly exposed to simulation education experiences in order to have a sense of psychological stability and to competently deliver medical treatment in a clinical setting. There is a practical limitation in that medical students do not have enough opportunities to meet the patients during clinical practice in hospitals. Therefore, in order to produce excellent doctors, students should have the expanded opportunities to experience simulation education so they can experience real-world medical conditions.

Patterns of Change in Approaches to Learning and Their Impact on Academic Performance Among Medical Students: Longitudinal Analysis

Several medical education studies suggest that deep approaches to learning (DA) are associated with better academic performance, whereas surface approaches (SA) are associated with worse academic performance. However, no study has assessed how these approaches change at the individual level during undergraduate medical training and how these trajectories contribute to academic performance. We assessed individual patterns of change in learning approaches throughout five years of medical training to determine whether and how DA and SA evolve during the curriculum and whether initial levels and rates of change predict performance in Year 5. Hypotheses: We hypothesized that (1) medical students have a higher preference for DA in comparison with SA; (2) these preferences change along the medical curriculum; and (3) DA predicts better academic performance. Method: Participants were 268 Geneva medical students (59% female) who completed the revised two-factor study process questionnaire in Years 1, 2, 3, and 5 of their 6-year curriculum. Student academic performance was registered in Year 5. Multivariate latent growth modeling was used to assess individual trajectories in learning approaches and test their associations with performance in Year 5. Results: Medical students were inclined to use DA rather than SA. Nevertheless, from Year 2 onward their use of DA decreased while their use of SA increased. Students with higher initial levels of DA tended to have lower initial levels of SA. Moreover, increases in SA were significantly associated with decreases in DA. However, only initial levels of DA and non-repeater status in Year 1 were positive and significant predictors of academic performance in Year 5. Conclusions: Although students tended to use DA rather than SA when entering medical school, their preferences for DA tended to decline throughout medical training while increasing for SA. Learning approaches during early study years, characterized by engagement and meaningful learning, predicted later academic performance. DA should be promoted during the early years of medical studies to foster student learning and to improve academic performance.

Empathy trajectories throughout medical school: relationships with personality and motives for studying medicine

Empathy remains a widely discussed topic within medical education research. Studies on empathy changes among medical students are not univocal: empathy may decline, remain stable or increase. A largely unexplored research question regards inter-individual variability in empathy change, namely if different longitudinal trajectories of empathy exist. Evidence on the association of empathy trajectories with personality and motives for studying medicine is also scarce. Here, latent growth modeling examined empathy (measured with the Jefferson Scale of Empathy) among 201 medical students (M_age = 20.74, 57% females) across three assessments: at entry year (Year 1) and during the first two clinical years (Years 4 and 5). Associations between empathy trajectories, personality in Year 1 and motives for studying medicine in Years 4 and 5 were tested. We identified two empathy trajectory groups: lower and decreasing (n = 59; 29%) and higher and stable (n = 142; 71%). Regression analyses indicated that higher openness in Year 1 was associated with an increased probability of higher and stable group membership (controlling for motives in Year 1). The effect of openness disappeared controlling for motives in Years 4 and 5 while caring for patients (in Years 4 and 5) and altruism (in Year 4) were positively associated with an increased probability of higher and stable group membership. In sum, we observed that empathy remains stable in most medical students and declines in fewer; openness and patients-oriented motives for studying medicine are associated with higher and stable empathy. Encouraging medical students' patients-oriented motives from preclinical throughout clinical years may prevent empathy decline.

Journey into uncertainty: Medical students' experiences and perceptions of failure

CONTEXT

Having succeeded in being selected for medical school, medical students are not always familiar with failure and yet they are expected to graduate prepared to effectively function in the failure-burdened arena of clinical medicine. Lacking in the developing literature on learners and failure is an exploration of how this transformation is accomplished. The purpose of this study was to examine how medical students perceive and experience failure during their medical school training.

METHOD

We used a qualitative description methodology to probe the failure experiences of medical students attending a Canadian medical school. Participants were provided with the broad definition of failure used in this research: 'deviation from expected and desired results.'In total, 12 students were sampled, three from each of the 4 years of study, and participated in individual, semi-structured interviews that were analysed using thematic analysis to identify and describe core themes.

RESULTS

At the start of medical school, students admitted limited experience with failure; their early descriptions were self-centred and binary. Personal stories recounted by preceptors encouraged students and helped them understand that physicians are human and that failure is inevitable. Students felt relatively protected from failures that could impact patients. Both witnessing and participating in a failure event were distressing and sometimes at odds with their expectations. Students expressed a desire to talk about the experience.

CONCLUSIONS

Medical students described examples of experiencing failure during medical school that transported them from the more certain black and white beginnings of their classroom into the uncertain shades of grey of clinical medicine. What the participants heard, saw and experienced suggests opportunities for classroom teachers to better prepare pre-clinical students for the inevitability of failure in clinical medicine and opportunities for clinical teachers to engage in open, inclusive conversations surrounding failures that occur on their watch.

Perceptions and processes influencing the transition of medical students from pre-clinical to clinical training

BACKGROUND

The transition from pre-clinical to clinical medical training is often characterised by several challenges which may have different impacts on students' well-being and learning experiences. To ensure smooth transition, it's important to understand how these students navigate through the challenging processes.

METHODS

This study employed a mixed-methods design using a survey, focus groups and interviews among medical students who had entered their first clinical year of study (Year 4). Using a 5-point Likert scale, survey participants rated items which related to their transition experience in the areas of professional socialisation; workload; patient contact; knowledge and skills; and learning and education. The qualitative questions explored challenges in transition, coping strategies and recommendations to foster smooth transitioning. The survey data was analysed using descriptive and inferential statistics while thematic analysis was used to establish emerging themes from the qualitative data. The Westerman Transition Framework was utilised in the triangulation of study findings.

RESULTS

A total of 141 students participated in the survey while 12 students participated in the focus group discussions and interviews. The quantitative part of the study showed that the students were anxious about the process and considered the workload to be heavy while also identifying gaps in their knowledge. Similarly, the qualitative findings revealed that workload and professional socialisation were identified as disruptive novel elements and the students also reported feelings of inadequacy and incompetence due to perceived knowledge gaps. These shortcomings and challenges were tackled by seeking support from peers and senior medical students as a way of coping with the anxiety and stress. As the students progressed, they admitted and accepted that the transition was a gradual process and an essential learning curve.

CONCLUSION

The process of transitioning from preclinical to clinical years is considered stressful and abrupt with the introduction of disruptive novel elements that create feelings of incompetence and unpreparedness in students. Educators need to consider developing social and developmental strategies that emphasise nurturing and empowering clinical learning environments and facilitate reflective and transformative life-long learning opportunities for students.

Virtual patient simulation in breaking bad news training for medical students

OBJECTIVE

The present study explores students' perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education.

METHODS

The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis.

RESULTS

Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs.

CONCLUSION

The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one's own communication behaviors in a stress-free environment.

PRACTICE IMPLICATIONS

The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.

Depression and Abuse During Medical Internships in Peruvian Hospitals

OBJECTIVE

To estimate the prevalence of depression and abuse and identify the associated factors in medical interns in Peruvian hospitals.

METHODS

We conducted a multicentre, cross-sectional and analytical study during the months of March to May 2016. We included medical interns from 18 Peruvian hospitals, in Lima and provinces. We used a survey that included sociodemographic data and a scale to measure the perception of abuse (psychological, physical and sexual). In addition, we used the Spanish version of the PHQ-9 to evaluate depression. We used Poisson regression with robust variances to calculate prevalence ratios (PRs).

RESULTS

A total of 402 medical interns participated in the study, the median age was 25 [IQR: 21-33], and 52.7% were male. Moreover, 25.4% of them suffered from depression. In the adjusted model, the variables associated with depression were age (PRa=1.15), the number of hours they sleep per day (PRa=1.23), being a woman (PRa=3.33), performing the internship in a province (PRa=0.25), studying at a public university (PRa=0.64), living with parents (PRa=0.65) or alone (PRa=0.33), and having perceived some type of abuse (PRa=1.07).

CONCLUSIONS

A quarter of surveyed medical interns had depression. Early screening is necessary to identify perceived abuse and other triggering depression factors that may adversely affect work performance and overall mental health during medical internships.

Stress, Burnout, and Associated Risk Factors in Medical Students

Objectives

To determine the prevalence of and the risk factors associated with burnout and stress for medical students in Saudi Arabia.

Methods

A cross-sectional, survey-based study was distributed between January and February 2018 among all 500 medical students from the first to fifth years in a medical college; 356 of the students responded (71.2% response rate). Burnout was measured using the Maslach Burnout Inventory-Student Survey (MBI-SS) while the stress level was measured using the 12-item General Health Questionnaire (GHQ-12). Socio-demographics, professional characteristics, and participation in extracurricular activities were also included as possible predictors of burnout and stress.

Results

The study revealed that the stress level was (51.7%, n= 184) and the rate of high burnout was (38.2%, n= 136), expressing high exhaustion (77.8%, n=277), high cynicism (65.7%, n=234), and low academic efficiency (45.5%, n=162). Half of the students (50%, n=178) participated in extracurricular activities and were involved in one or more activities such as organizing activities and medical volunteering (n = 52, 14.6%), research (n = 59, 16.6%), and physical exercise (n = 71, 10.4%). There was a statistically significant positive correlation between overall burnout and a lower grade point average (GPA) (OR = 0.581, p 0.004, 95% CI = 0.400 to 0.843). A statistically significant positive correlation was found between stress and students with a lower GPA (OR = 0.737, P = 0.0.23, 95% CI = 0.566 to 0.959); stress was also higher in students who were not involved in any extracurricular activities (OR 1.893, P = 0.004, 95% CI = 1.22 to 2.918).

Conclusion

Our study shows high burnout rates among medical students. Low GPA students in this study showed a higher overall burnout. Stress was high in our study participants and was higher in students with a low GPA and in students who were not involved in any extracurricular activities.

Prevalence of hypochondriac symptoms among health science students in China: A systematic review and meta-analysis

BACKGROUND

Hypochondriac symptoms are commonly reported in health science students. With their incomplete medical knowledge, they may compare their own bodily symptoms with disease symptoms during the process of learning, which can lead to mental distress and the need for repeated medical reassurance.

OBJECTIVE

To estimate the prevalence of hypochondriac symptoms in Chinese health science students.

METHODS

A systematic literature search was conducted on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Data on July 1, 2018. Additionally, the references of the retrieved papers were searched. Cross-sectional studies published in either English or Chinese that reported the prevalence of hypochondriac symptoms in health science students were included. The selection process was executed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and study quality was assessed with the checklist recommended by the Agency for Healthcare Research and Quality for cross-sectional studies. A random-effects model according to the DerSimonian-Laird method was used to calculate the pooled prevalence.

RESULTS

Seven cross-sectional studies involving 6,217 Chinese health science students were included. The pooled prevalence of hypochondriac symptoms among health science students was 28.0% (95% CI = 19.0%-38.0%). The symptoms were a little more common in females (30.0%, 95% CI = 19.0%-42.0%) than in males (29.0%, 95% CI = 16.0%-42.0%), but the difference was not significant. No significant differences were found between participants grouped by study year. Only three studies explored the coping styles of students with hypochondriasis, and these revealed a high tendency toward help-seeking behaviors.

CONCLUSION

Our systematic review and meta-analysis showed a high prevalence of hypochondriac symptoms among health science students, indicating that it is a noteworthy phenomenon. We suggest that counseling and other support services are necessary for health science students.

Beyond the struggles: a scoping review on the transition to undergraduate clinical training

CONTEXT

The transition to clinical training within medical school is often seen as a struggle and students remain in distress despite numerous efforts to minimise threats. Efforts to change this may be misdirected if they are based on narrow conceptualisations of transitions. The authors conducted a scoping review to explore existing conceptual perspectives regarding the transition within medical school from pre-clinical training to clinical training to suggest a research agenda and practical implications.

METHODS

Between October 2017 and February 2018 the authors searched PubMed, MEDLINE, ERIC, PsycINFO, Web of Science and CINAHL for English language literature with no date limits and retrieved 1582 articles; 46 were included in this review. Two reviewers independently screened articles and extracted data. Data were then charted, analysed and discussed with the research team.

RESULTS

The transition to clinical training was often described negatively as 'difficult', 'a problem' and 'a struggle'. Our analysis found that researchers in medical education conducted studies on the transition to clinical training from three conceptual perspectives: educational; social, and developmental. Most research approached the transition to clinical training as a problem to be addressed from an educational perspective through transition to clerkship courses and curriculum innovations. Some research was conducted from a social perspective, focusing on building relationships. Regarding development, authors found a few articles highlighting opportunities for personal and professional development by nurturing transferrable learning strategies and reflection.

CONCLUSIONS

This review provides an empirical base on which future research can be built to better understand and support medical students' ability to navigate change. Finding new perspectives to approach the transition to clinical training could allow researchers to look beyond preparing students for struggles.

Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection

Medical students are expected to perform common procedures such as suturing on patients during their third-year clerkships. However, these experiences are often viewed by medical students as stressors rather than opportunities for learning. The source of this stress is the lack of instruction on common procedures prior to being asked to observe or perform the procedure on a patient. First-time exposures to procedures in stressful environments may result in decreased confidence in medical students and decrease the frequency with which they perform these procedures in the future. The authors sought to change this paradigm by: (1) introducing a suturing module to first-year medical students in the context of the anatomy dissection laboratory and (2) measuring its effects on student attitudes and behavior over the course of their third-year clerkships when they encounter patients. The authors found that early and prolonged introduction to suturing was associated with increased student confidence relative to suturing a patient. Participation in the suturing module was associated with increased student confidence in identifying suturing instruments (P < 0.001) and suturing patients (P = 0.013). Further it positively affected their behavior as demonstrated by increased performance of suturing events from students exposed to the suturing module. (P < 0.001) This study demonstrates that early and prolonged opportunities to practice a procedural skill in a low-stress environment increases student confidence during patient interactions and alters student behavior.

Burnout Prevalence and Associated Factors Among Brazilian Medical Students

OBJECTIVES

This study aims to identify the prevalence of burnout and associated factors in Brazilian medical students.

METHODS

In the largest medical school from Central Brazil, the Maslach Burnout Inventory-Student Survey and a socio-demographic questionnaire were adopted in this cross-sectional study. Correlations among the three dimensions of burnout were verified.

RESULTS

The evaluation of 399 students revealed a frequency of 12.0% of burnout. Women had a higher rate of burnout (8.0%) than men (4.0%). The fifth period had the higher frequency of burnout (27.1%), while the seventh grade had the lower frequency (2.1%). The students showed high scores only in emotional exhaustion (63.2%). Between the dimensions "emotional exhaustion" and "disbelief" found a significant correlation.

CONCLUSION

The fifth period of the Medicine course and the female gender are the most affected by burnout syndrome and therefore, the preventive actions to reduce stress among medical students should be directed mainly at these higher risk categories. The low burnout rate found in our study can attest that the PBL methodology and medical schools strategically located to meet regional demand may represent strategies for the prevention of burnout among medical students.

Midwifery students' experiences of learning clinical skills in Iran: a qualitative study

METHODS

A qualitative study was used. Midwifery students from three universities in Iran participated. The study used a convenience sample of eighteen students. Data for this study was collected using semi-structured interviews (N=12) and focus groups (N=6). Data were recorded on a digital audio recorder and then transcribed. The qualitative data were analyzed using a content analysis approach.

RESULTS

Six broad themes emerged from the analysis: Limited opportunities to experience skills, difficulties with course plan gaps, need for creating a supportive clinical environment, learning drives, confusion between different methods, and stress in the clinical setting. Short verbatim quotations from the participants were presented to provide evidence for the interpretation of data.

CONCLUSIONS

The findings of this study have provided a clear picture of the factors and mechanisms involved in learning clinical skills by midwifery students. This study showed that students had some difficulties and concerns during learning of clinical midwifery skills. The findings of this study suggest that midwifery educators conduct further studies to tackle these issues in clinical skills learning. The findings of this study are subject to some limitations which are discussed.

Fear, an unpleasant experience among undergraduate midwifery students: A qualitative study

Fear is a normal emotion that can evoke an appropriate response when facing threat. However, sometimes the consequences of fear can lead to responses that are maladaptive. Fear can have negative effects on learning. Research has focused on the experience of fear and its consequences among midwifery students during their undergraduate program. A qualitative analysis was conducted of interviews with ten midwifery students in different years of an undergraduate program. The data was analyzed through a content analysis approach. Two main categories and five subcategories emerged. The first category, areas of fear in midwifery students, consisted of the following subcategories: fear of doing harm, fear of encountering their first childbirth, and fear of penalties. The second category, consequences of fear, consisted of the following subcategories: general physical and psychological consequences and interference in adopting the professional role. In this study, fear not only raised the students' stress levels thereby, leading to physical and psychological issues but also hindered their adoption of their professional role. These findings will potentially inform support and retention strategies within midwifery undergraduate programs in the future.

BACKGROUND

Maternity care in Iran is provided mainly within a medical model of care. The majority of women give birth in hospital, where care is provided by midwives who work under the direction and supervision of an obstetrician. Midwives within the medically dominated system lack autonomy and have very little opportunity to gain experience in providing continuity of care for women as midwife-led models of care are rare. This practice context means that midwifery students have very little opportunity to gain experience in autonomous midwifery practice. Midwifery undergraduate program in Iran is for four years. Admission to the undergraduate program is implemented via a direct entry route. Nearly all of the midwifery students are school leavers with their first exposure to university and hospital systems. Most of the midwifery students have chosen this career without sufficient understanding about midwifery and the work that it involves (Arfaee et al., 2008). The midwifery undergraduate program comprises theoretical and clinical elements. After the first semester, students enter clinical settings under the supervision of their clinical instructors.

Evaluating validity of current criteria for judgment passing ER rotation among internee medical students

Background

Passing the emergency medicine internship is an essential process for all graduates of medical schools. The main purpose of this study was to evaluate validity of current criteria for judgment passing ER rotation among internee medical students.

Methods

In this cross-sectional study, a total of 200 students in the emergency departments (ED) of the teaching hospitals at Tehran University of Medical Sciences (TUMS) were included. The data were gathered using by a valid self-assessment questionnaire including demographic information and 12-items about the students' level of confidence with the skills and procedures under study. Statistical analyses were done using SPSS (version 22).

Results

200 medical students participated in this study. A Univariate analysis showed a significant correlation between successfuly completions of training in emergency medicine (passing emergency medicine in past rotations) with some items in self-assessment questionnaire same as knowledge of interns in managing emergency situations (p = 0.009). The Spearman test demonstrated a significant correlation between the duration of emergency training (number of months which interns spent on the emergency training) with the some items in self-assessment questionnaire same as importance of emergency medicine training (p = 0.019).

Conclusions

According to association between successfully completions of training in emergency medicine and self-assessment questionnaire, it seems current criteria for judgment passing emergency medicine rotation is valid as well as we recommended using self-assessment for evaluating validity of such testes.

•

Previous studies have shown that the results of clinical tests in emergency medicine and other clinical education courses do not correlate accurately with a medical student's degree of confidence in performing tasks and their readiness for future career.

•

Validity and authenticity of clinical test in emergency medicine and other clinical education course must be evaluated to ensure that these examinations predict whether the students who pass have greater skills and confidence when compared to the ones who fail the rotation.

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Self-assessment is an effective tool for evaluating validity of clinical tests.

Breaking bad news to patients with spinal cord injury in Turkey - physiatrists' perspective

OBJECTIVE

To explore Turkish physiatrists' experiences and opinions about breaking bad news (BBN) to patients with spinal cord injury (SCI).

DESIGN

A cross sectional study.

SETTING

Turkey.

PARTICIPANTS

Sixty-nine physiatrists completed a questionnaire about experiences and opinions regarding BBN and self-assessment of communication skills (CS).

RESULTS

Eleven percent of specialists and 53% of residents were trained on basic CS. All participants believed that physiatrists should play a role in BBN and the majority reported that they delivered the bad news in their clinic. Sixty-seven percent believed that the primary responsibility belongs to physiatrists. Sixty-eight percent reported that the most appropriate time for BBN is during rehabilitation. Self-assessments of CS were considered satisfactory in most steps of SPIKES protocol. Twenty percent told absolute truth to patients while 80% stated that they did so sometimes or partially. Only 41% confirmed that they do not use unrealistic statements to comfort patients. Fewer than 60% stated that they performed the most appropriate and excellent behaviors for items in "empathy" section.

CONCLUSION

Physiatrists had different opinions about the style of BBN. Self-assessments of CS were optimistic, however physiatrists were not fully satisfied with their empathy skills.

Prevalence of alcohol use disorders among under- and post-graduate healthcare students in Italy

A cross-sectional study was carried out on 641 medical students, 359 students attending a degree course in the healthcare professions, and 500 resident physicians, all undergoing health surveillance at the ambulatory of the Division of Occupational Medicine, Second University of Naples, Italy. 76.1% of the participants drank alcohol, with 85.5% of medical students, 77.4% of resident physicians, and 63% of healthcare-professions students reporting regular alcohol use. In the whole sample, the mean Audit-C score was 1.6 for men and 1.1 for women; only 5.5% of men and 7.1% of women had a hazardous alcohol consumption with an Audit-C score of respectively ≥4 and ≥3. Multivariate regression modeling revealed that regular alcohol use was more likely in individuals who were men, were younger, had a lower body-mass index, were active smokers, were habitual coffee drinkers, and who were resident physicians or medical students rather than healthcare-professions students. This finding identifies a need to assess alcohol use in medical-profession workers in order to identify risky behavior early on and to carry out rapidly effective preventive and curative interventions.

Effects of Anxiety on Novice Genetic Counseling Students' Experience of Supervised Clinical Rotations

Supervised clinical experiences with patients comprise a critical component of genetic counseling student education. Previous research has found genetic counseling students tend to be more anxiety prone than the general population, and anxiety related to supervision has been found in genetic counseling and related fields. The present study investigated how anxiety affects the experience of supervision for genetic counseling students. Second year genetic counseling students were invited to participate through email invitations distributed via training directors of the 33 programs accredited at the time of the study by the American Board of Genetic Counseling. An initial online survey contained the trait scale of the State-Trait Anxiety Inventory to estimate anxiety proneness in this population and an invitation to participate in a 45-minute semi-structured phone interview focusing on students' experiences of supervision during their clinical rotations. High and low trait anxiety groups were created using STAI scores, and the groups' interview responses were compared using consensual qualitative research methodology (CQR; Hill 2012). The high anxiety group was more likely to describe problematic supervisory relationships, appreciate the supervisor's ability to help them when they get stuck in sessions, and feel their anxiety had a negative effect on their performance in general and in supervision. Common themes included supervisors' balancing support and guidance, the importance of feedback, ego-centric responses, and supervisors as focal points. The results of the present study are largely consistent with current literature. Further research findings and research, practice, and training recommendations are provided.

Stress, Burnout and Coping Strategies in Preclinical Medical Students

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.

Extracurricular activities associated with stress and burnout in preclinical medical students

This study aims to assess the prevalence of stress and burnout among preclinical medical students in a private university in Beirut, Lebanon, and evaluate the association between extracurricular involvement and stress and burnout relief in preclinical medical students. A cross-sectional survey was conducted on a random sample of 165 preclinical medical students. Distress level was measured using the 12-item General Health Questionnaire (GHQ-12) while that of burnout was measured through the Maslach Burnout Inventory-Student Survey (MBI-SS). The MBI-SS assesses three interrelated dimensions: emotional exhaustion, cynicism, and academic efficacy. Extracurricular activities were divided into four categories: physical exercise, music, reading, and social activities. All selected participants responded. A substantial proportion of preclinical medical students suffered from stress (62%) and burnout (75%). Bivariate and multivariate regression analyses revealed that being a female or a 1st year medical student correlated with higher stress and burnout. Music-related activities were correlated with lower burnout. Social activities or living with parents were associated with lower academic efficacy. The high stress and burnout levels call for action. Addressing the studying conditions and attending to the psychological wellbeing of preclinical medical students are recommendations made in the study.

Medical student syndrome: fact or fiction? A cross-sectional study

Objectives

It is often reported by medical practitioners that medical students develop hypochondriacal concerns and symptoms relating to diseases they are studying, a phenomenon labelled ‘medical student syndrome’. However, the evidence that this syndrome exists and particularly that it contributes to an increased number of consultations (as typical hypochondriasis does) is weak. The present study investigates this phenomenon in terms of differences between medical and non-medical students in help-seeking behaviour.

Design

Cross-sectional survey.

Setting

Three universities in London.

Participants

Medical students (n = 103), non-medical science student controls (n = 107) and law student controls (n = 78), all third-year undergraduates, were recruited from within their universities.

Main outcome measures

Help-seeking behaviour was measured using the ‘Health Anxiety Questionnaire’ reassurance-seeking behaviour subscale; the overall number of doctors’ visits made for new health complaints since beginning university; a new ‘Hypochondriacal and Help-Seeking Behaviour’ scoring-system, which asked questions pertaining to not just the number but the nature of consultations, identifying participants who had experienced health concerns that were disproportionate to the diseases diagnosed.

Results

No significant differences were found between medical students and either control group in any of the main outcome variables.

Conclusions

These findings fail to support the notion that medical students, more so than other students, seek medical advice for hypochondriacal health concerns. They are pertinent to clinicians due to the potentially negative consequences of incorrectly assuming medical students to behave in this way, including cursory evaluations and disintegration of the doctor–patient relationship.

Teaching first-year medical students in basic clinical and procedural skills--a novel course concept at a medical school in Austria

Introduction: Clerkships are still the main source for undergraduate medical students to acquire necessary skills. However, these educational experiences may not be sufficient, as there are significant deficiencies in the clinical experience and practical expertise of medical students.

Project description: An innovative course teaching basic clinical and procedural skills to first-year medical students has been implemented at the Medical University of Graz, aiming at preparing students for clerkships and clinical electives. The course is based on several didactic elements: standardized and clinically relevant contents, dual (theoretical and virtual) pre-course preparation, student peer-teaching, small teaching groups, hands-on training, and the use of medical simulation. This is the first course of its kind at a medical school in Austria, and its conceptual design as well as the implementation process into the curriculum shall be described.

Evaluation: Between November 2011 and January 2013, 418 students have successfully completed the course. Four online surveys among participating students have been performed, with 132 returned questionnaires. Students’ satisfaction with all four practical course parts was high, as well as the assessment of clinical relevance of contents. Most students (88.6%) strongly agreed/agreed that they had learned a lot throughout the course. Two thirds of the students were motivated by the course to train the acquired skills regularly at our skills laboratory. Narrative feedbacks revealed elements contributing most to course success.

Conclusions: First-year medical students highly appreciate practical skills training. Hands-on practice, peer-teaching, clinically relevant contents, and the use of medical simulation are valued most.

Measuring the ambiguity tolerance of medical students: a cross-sectional study from the first to sixth academic years

BACKGROUND

Tolerance of ambiguity, or the extent to which ambiguous situations are perceived as desirable, is an important component of the attitudes and behaviors of medical students. However, few studies have compared this trait across the years of medical school. General practitioners are considered to have a higher ambiguity tolerance than specialists. We compared ambiguity tolerance between general practitioners and medical students.

METHODS

We designed a cross-sectional study to evaluate the ambiguity tolerance of 622 medical students in the first to sixth academic years. We compared this with the ambiguity tolerance of 30 general practitioners. We used the inventory for measuring ambiguity tolerance (IMA) developed by Reis (1997), which includes three measures of ambiguity tolerance: openness to new experiences, social conflicts, and perception of insoluble problems.

RESULTS

We obtained a total of 564 complete data sets (return rate 90.1%) from medical students and 29 questionnaires (return rate 96.7%) from general practitioners. In relation to the reference groups defined by Reis (1997), medical students had poor ambiguity tolerance on all three scales. No differences were found between those in the first and the sixth academic years, although we did observe gender-specific differences in ambiguity tolerance. We found no differences in ambiguity tolerance between general practitioners and medical students.

CONCLUSIONS

The ambiguity tolerance of the students that we assessed was below average, and appeared to be stable throughout the course of their studies. In contrast to our expectations, the general practitioners did not have a higher level of ambiguity tolerance than the students did.

Perceived levels of frustration during clinical situations in athletic training students

CONTEXT

Athletic training students (ATSs) are involved in various situations during the clinical experience that may cause them to express levels of frustration. Understanding levels of frustration in ATSs is important because frustration can affect student learning, and the clinical experience is critical to their development as professionals.

OBJECTIVE

To explore perceived levels of frustration in ATSs during clinical situations and to determine if those perceptions differ based on sex.

DESIGN

Cross-sectional study with a survey instrument.

SETTING

A total of 14 of 19 professional, undergraduate athletic training programs accredited by the Commission on Accreditation of Athletic Training Education in Pennsylvania.

PATIENTS OR OTHER PARTICIPANTS

Of a possible 438 athletic training students, 318 (72.6%) completed the survey.

MAIN OUTCOMES MEASURE(S)

The Athletic Training Student Frustration Inventory was developed and administered. The survey gathered demographic information and included 24 Likert-scale items centering on situations associated with the clinical experience. Descriptive statistics were computed on all items. The Mann-Whitney U was used to evaluate differences between male and female students.

RESULTS

A higher level of frustration was perceived during the following clinical situations: lack of respect by student-athletes and coaching staffs, the demands of the clinical experience, inability of ATSs to perform or remember skills, and ATSs not having the opportunity to apply their skills daily. Higher levels of frustration were perceived in female than male ATSs in several areas.

CONCLUSIONS

Understanding student frustration during clinical situations is important to better appreciate the clinical education experience. Low levels of this emotion are expected; however, when higher levels exist, learning can be affected. Whereas we cannot eliminate student frustrations, athletic training programs and preceptors need to be aware of this emotion in order to create an environment that is more conducive to learning.

Clinical training stress-inducing factors from the students' viewpoint: a questionnaire-based study

Improving the quality of clinical training requires provision of suitable educational environment and one of its requirements is determination of the stress-inducing factors. The present research was carried out to explore these factors from the viewpoint of students of nursing school. This research was a descriptive study. The samples included a total of 230 students who had passed at least one credit of clinical training and had been selected through convenience sampling. Based on the research results, the most tension-inducing area was related to the unpleasant emotions area, clinical experiences, unpleasant feelings, educational environment and interpersonal relationships, respectively. Throughout clinical training processes, students of different medical fields face a great deal of tension-inducing factors. The identification of these factors could play a significant role in reducing the amount of tension among them.

Medical students themselves as surrogate patients increased satisfaction, confidence, and performance in practicing injection skill

BACKGROUND

Injection skill is one of procedural skills usually taught to medical students. Lack of experience and confidence in their ability creates nervousness, anxiety, and leads to poor performance in giving an injection to patient.

AIMS

To evaluate the satisfaction on teaching method, perceptions of confidence and feeling of empathy to the patients, and performance in injection skill of medical students toward practicing injection skill using manikin only compared to additional training using themselves as surrogate patients.

METHODS

Control group consisted of year 5 medical students, who completed studying injection skill from computer assistant instruction, demonstration, and practicing with manikin. The intervention group in addition to those conventional learning methods, directly experienced injection skill using themselves as surrogate patients and received direct feedback from their peers. Both group had a chance to perform injection to actual children and were assessed while performing the injection for their performance of injection procedures. Upon completion of the entire learning process, the students were asked to answer questionnaire presented with Likert-type scales.

RESULTS

There were 57 students in the control group and 32 in the intervention group who completed the study. The intervention group reported significantly higher satisfaction on the teaching method, higher level of confidence and empathy to the children who were given injection, and had significantly better performance in preparing the children and giving injection. Both groups are not different in checking accuracy of order, preparing vaccine, selecting injection site, sterile techniques, handling of instruments and injection site, documentation, and explaining to children/parents.

CONCLUSIONS

Direct experience by medical students themselves as surrogate patients is an appropriate option for learning injection skill and can enhance the student performance, and therefore should be encouraged.

An integrated virtual family curriculum to introduce specialty-specific clinical skills to rising third-year medical students

BACKGROUND

Transitioning from a preclinical to a clinical curriculum can be challenging for medical students. As a central component of a new 3-week transition course, we designed, implemented, and evaluated an innovative Virtual Family Curriculum to introduce rising 3rd-year medical students to the knowledge, skills, and cultures of 6 core medical and surgical specialties.

DESCRIPTION

The authors designed a 6-case, 24-hour, 3-generation Virtual Family Curriculum and a 6-station summative Objective Structured Clinical Examination (OSCE). Each case contains a lecture, video, discussion questions, skills practice, and faculty guide. We used both qualitative and quantitative evaluation methods.

EVALUATION

Ninety-eight students took the inaugural course in 2012. All students passed the final OSCE. Students rated the virtual family curriculum a 5.17/6 (6 = highest). Comments about the curriculum were uniformly positive.

CONCLUSIONS

We created and implemented an integrated Virtual Family Curriculum that systematically teaches specialty-specific knowledge and skills. This curriculum facilitates students' transition to clinical clerkships.

Preclinical students' experiences in early clerkships after skills training partly offered in primary health care centers: a qualitative study from Indonesia

BACKGROUND

Students may encounter difficulties when they have to apply clinical skills trained in their pre-clinical studies in clerkships. Early clinical exposure in the pre-clinical phase has been recommended to reduce these transition problems. The aim of this study is to explore differences in students' experiences during the first clerkships between students exclusively trained in a skills laboratory and peers for whom part of their skills training was substituted by early clinical experiences (ECE).

METHODS

Thirty pre-clinical students trained clinical skills exclusively in a skills laboratory; 30 peers received part of their skills training in PHC centers. Within half a year after commencing their clerkships all 60 students shared their experiences in focus group discussions (FGDs). Verbatim transcripts of FGDs were analyzed using Atlas-Ti software.

RESULTS

Clerkship students who had participated in ECE in PHC centers felt better prepared to perform their clinical skills during the first clerkships than peers who had only practiced in a skills laboratory. ECE in PHC centers impacted positively in particular on students' confidence, clinical reasoning, and interpersonal communication.

CONCLUSION

In the Indonesian setting ECE in PHC centers reduce difficulties commonly encountered by medical students in the first clerkships.

Stress responses in medical students in ambulatory and in-hospital patient consultations

CONTEXT

 Little is known about health professionals' responses to acute stressors encountered in the clinical environment. The goal of this study was to measure the subjective and physiological stress responses of medical students to consultations in familiar (in-hospital) and unfamiliar (ambulatory) settings. We hypothesised that: (i) providing a consultation in an unfamiliar setting would result in increased stress responses in medical students, and (ii) some differences in stress responses according to gender might become apparent.

METHODS

A quantitative cross-over study was conducted over a 6-month period. Participating students were invited to provide consultations to patients in an ambulatory setting. In order to provide a control condition, each student was required to conduct a similar consultation (without reporting back to the patient) with an in-hospital patient during his or her rotation in internal medicine. Pre- and post-consultation subjective and physiological responses were measured using a visual analogue scale (VAS), the State-Trait Anxiety Inventory (STAI), a cognitive appraisal scale and salivary cortisol levels.

RESULTS

All of the subjective and physiological stress responses were greater in the ambulatory setting than the in-hospital setting. There was an effect of gender on the responses. Women showed greater pre-consultation subjective stress levels in the ambulatory setting, whereas men exhibited greater physiological stress levels in the ambulatory setting. No correlations were observed between subjective and cortisol responses.

CONCLUSIONS

Ambulatory consultations are more stressful for medical students than consultations carried out in the more familiar in-hospital setting. Further studies should be conducted to investigate the nature of the stressors in this particular environment, to explore the possible explanations for a gender effect, and to explore the effects of these stress responses on students' diagnostic skills.

Comparison of three clinical environments for pre-clinical clinical skills training

OBJECTIVES

Primary health care (PHC), secondary health care (SHC), and tertiary health care (THC) were compared in search of the most suitable setting for clinical skills training of pre-clinical students.

METHODS

The Dundee Ready Educational Environment Measure questionnaire was presented to 300 clerkship students of the Faculty of Medicine at Gadjah Mada University, Indonesia who were attached to PHC, SHC, and THC settings. Students were asked to assess their current attachment for suitability for training of pre-clinical students. Semi-structured interviews were held with 46 clinical supervisors based on the three types of settings.

RESULTS

Clerkship students preferred PHC centers over SHC and THC hospitals for clinical skills training of pre-clinical students (p < 0.05). PHC staff felt their centers to be well-equipped to train pre-clinical students, including availability of supervisors' time for teaching, adequate physical facilities and equipment, and suitable patient cases.

CONCLUSION

In the developing country context, PHC centers seemed more appropriate for clinical skills training of pre-clinical students than SHC and THC hospitals. However, the skills laboratory must guard that clinical skills are trained and performed in the same way in that facility, in PHC centers and in teaching hospitals.

Effects of partial substitution of pre-clinical skills training by attachments to primary health care centers: An experimental study

BACKGROUND

Recent studies indicate that students may encounter problems when they have to apply clinical skills learned in a skills laboratory to patients. To facilitate this transition, it has been advised to include patient contacts early in the pre-clinical curriculum.

OBJECTIVE

To compare clinical skills performance and level of preparedness for entering the clerkships between students who were prepared exclusively in a skills laboratory and peers for whom part of their skills training program was substituted by training in a primary health care (PHC) center.

METHODS

Pre-clinical students either trained clinical skills exclusively in a skills laboratory while their peers attended a mixed program of laboratory trainings and practice in PHC centers. Students' perception of preparedness for the clerkships was explored through the Preparation for Hospital Practice Questionnaire. Students' clinical skills were assessed by an Objective Structured Clinical Examination (OSCE) and by supervisors in PHC centers.

RESULTS

Students following the mixed program felt better prepared for their clerkships than skills lab-trained peers. Students' perceptions were supported by assessments by their supervisors. However, mean OSCE scores of both groups did not differ significantly.

CONCLUSION

PHC centers can be involved to better prepare pre-clinical students for their clerkships.

The prevalence, causes, and consequences of experiencing a life crisis during medical school

BACKGROUND

Little is known about the prevalence, causes, and consequences of experiencing a major life crisis during medical school.

PURPOSE

The objective is to describe the prevalence, causes, and consequences through internship of experiencing a major life crisis while enrolled as a medical student at Uniformed Services University (USU).

METHOD

USU graduates from 1980 to 1999 were surveyed regarding their experiences at USU and career milestones. Predictor markers were obtained from the USU Admissions, Promotions, and Registrar's office. Outcome data were derived from a survey of intern program directors from the years 1993 to 1999.

RESULTS

There were 1,807 (67%) of USU graduates who responded to our survey. There were 394 (22%) who reported experiencing a major life crisis during medical school. Graduates reporting a major life crisis performed slightly poorer in terms of basic science GPAs (2.95 vs. 2.85, p <.001), USMLE exam scores, and performance ratings by their program directors than did graduates who did not experience a crisis.

CONCLUSIONS

A large fraction of medical students experience major life crises. The effects of these crises may persist throughout internship.

Reassuring the medical students' disease--health related anxiety among medical students

BACKGROUND

Studying a specific illness could lead medical students to an incorrect interpretation of certain physical symptoms, so that symptoms which were previously considered normal are now regarded as a true sign of an illness.

AIM

To examine the appraisal of self-health state, the existing fear of morbidity and the level of health-related anxiety among medical students throughout medical school.

METHODS

Anonymous questionnaires were distributed to first through sixth year medical students at the Tel-Aviv University Medical School. The questionnaires were distributed to all the students who were present on the study days.

RESULTS

We observed a significant rise in the emotional-distress process with entering the clinical years followed by a significant decrease later on. Similar pattern was seen in health anxiety and in preoccupation with and fear of illness and death. While the perceptual-cognitive process increased gradually, there was no change in interference with life scores.

CONCLUSION

"Medical student's disease" should be regarded as a phenomenon depending on the years of learning. By breaking it down into its components, one can better characterize it and predict its onset. By defining it as a normal process, one can assist in guiding medical students to reduce their level of anxiety and distress.