Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic

Exploring the perceptions of the effect of the COVID-19 pandemic on the mental well-being and medical education of medical students in Northern Ireland, in addition to the perceived barriers to seeking support; a qualitative study

INTRODUCTION

The COVID-19 pandemic had a negative effect on population mental health. Medical students may have been particularly affected, whom prevalence of mental health conditions was already high before the pandemic hit, due to the difficult and stressful academic programme. In Northern Ireland specifically, mental well-being levels are the lowest across the UK; however limited research exists examining the medical student cohort. This study explores Northern Irish medical students' perceptions on how the pandemic affected their mental health, their progress within medical education and perceived barriers to accessing support services in Northern Ireland.

METHODS

A qualitative study of phenomenological design involving 15 in-depth semi-structured interviews. The interviews were conducted amongst individuals who were 1st-4th year medical students when the pandemic was officially declared in Northern Ireland in March 2020. The interviews were transcribed, and thematic analysis was carried out using NVivo V12 qualitative data analysis software.

RESULTS

Results demonstrated the COVID-19 pandemic had a considerable negative impact on participants' mental health; a variety of interlinked social, individual and/or psychological and organisational factors led to increased levels of stress, anxiety and depression. This had a secondary negative impact on participants' medical education progress through reducing motivation, causing burnout and impostor syndrome. Unexpectedly; there were some perceived positive outcomes, including improved appreciation for work-life balance and resilience. Participants reported various barriers to seeking help amongst this difficult time period; also categorizable into social, individual and/or psychological and organisational factors, for example; stigmatisation, fear and perfectionistic tendencies.

DISCUSSION AND CONCLUSION

There is a pressing demand for heightened support availability, personally tailored mental health assistance and an effort to reduce mental health stigma in Northern Ireland. This study highlights the complex multifactorial nature of mental health. Medical schools must provide additional services to protect well-being during particularly challenging periods and dismantle the barriers preventing individuals from accessing vital support.

Coronavirus pandemic derived demands and inclusive leadership on junior doctors' well-being

BACKGROUND

International studies have revealed that numerous challenges (e.g. job demands) and opportunities (e.g. job resources as protective factors) affect the well-being of healthcare workers.

AIMS

Building on the job demands-resources theory, we explored how job-related demands and the role of inclusive leadership as a job resource influenced the well-being of junior doctors during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional web survey was conducted in July 2022 for 82 junior doctors who had experienced the 3-year COVID-19 pandemic. The survey captured their perceived physical, psychological and COVID-19-related job demands and the inclusive leadership behaviours exhibited by their clinical unit supervisors as job resources. Data were also collected on junior doctors' experiences of burnout, compassion satisfaction and occupational commitment as variables of job outcomes. Hierarchical linear regression analysis was applied to explore the relationships between the variables.

RESULTS

Physical and COVID-19-related job demands were associated with increased burnout among junior doctors. Inclusive leadership as a job resource was associated with junior doctors' reduced burnout and increased compassion satisfaction and buffered the negative effects of psychological demands on their compassion satisfaction. Only COVID-19-related job demands were associated with junior doctors' occupational commitment.

CONCLUSIONS

Our study highlights the critical effects of COVID-19-related job demands on junior doctors' burnout and occupational commitment. Inclusive leadership behaviours exhibited by clinical unit supervisors are a valuable job resource, which can be incorporated as one of the competencies training for medical staff.

Medical students' attitudes towards well-being and welfare: a systematic review protocol

INTRODUCTION

Medical education poses serious stressors on medical students, as they report overall higher rates of psychiatric comorbidities compared with students enrolled in other university-level courses. The high rates of poor well-being reported should be considered a concern, as students represent the future workforce of healthcare professionals. Although there has been an increased interest towards well-being and burn-out in medical students, there is still much to be elucidated. Indeed, there is an overall lack of understanding of which attitudes medical students have towards well-being and welfare, something that could be used to develop targeted practice to improve medics' quality of life and reduce overall burn-out.This review will aim at evaluating and reporting the current research available on medical students' attitudes towards well-being and welfare. We will take into account which countries have published data on the topic, and we will analyse papers written during the COVID-19 period separately, giving this particular time frame a separate outlook.

METHODS AND ANALYSIS

This systematic review protocol has been developed following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. A systematic search including "medical students" AND "wellbeing" AND "perceptions" was carried out on MEDLINE, Embase and Scopus databases. The Mixed Method Appraisal Tool will be used to assess the quality of the available studies and risk of bias. Studies will be screened using predetermined inclusion and exclusion criteria. Data will be summarised narratively and in tabular forms. A narrative subgroup analysis of the COVID-19 period will be carried out, and a country-wise approach will be used to describe which areas have published relevant studies.

ETHICS AND DISSEMINATION

This will be the first systematic review looking at the reported attitudes that medical students have towards well-being and welfare. This will provide an account of the available data on the topic, and a starting point to understand where further research is needed in the future.

PROSPERO REGISTRATION NUMBER

CRD42023471022.

Cultural moderation in sports impact: exploring sports-induced effects on educational progress, cognitive focus, and social development in Chinese higher education

BACKGROUND

This research examines the nuanced challenges confronting Chinese university students within the dynamic milieu of Chinese education. The study comprehensively investigates factors encompassing educational progress, social development, cognitive focus, and Psychological Well-being (PWB), specifically emphasizing the role of sports participation.

METHODS

To scrutinize the moderation-mediation nexus between cultural context and social development, a distribution of 500 questionnaires was administered to Chinese university students, yielding 413 responses, corresponding to an 82.6% response rate. Methodologically, this study employed moderation and mediation analyses, incorporating statistical techniques such as a principal component matrix, factor analysis, and hierarchical regression.

FINDINGS

Prominent findings underscore the significant impact of age on educational progress, shaping the trajectory of academic advancement. Cumulative Grade Point Average (CGPA) emerges as a promising metric, establishing a link between academic performance and educational progress. Active involvement in sports and physical activities (PSPA) positively affects academic performance and study habits. Participation in sports teams and clubs (ISTC) enriches social development by nurturing interpersonal relationships, teamwork, and leadership skills. Sports activities (ESA) correlate with enhanced cognitive focus and improved psychological well-being. Significantly, the findings unveil a nuanced association between Perceived Social Development Through Sports (PSDTS) and educational progress.

CONCLUSIONS

Cultural Context (CC) moderates PSDTS, Sport-induced Cognitive Focus (SICF), and PWB, influencing educational progress. This study emphasizes the need for enhanced support systems-academic guidance, awareness, sports programs, and cultural competence training-to advance student well-being and academic achievement in China, fostering an empowering educational environment for societal progress.

Determinants of workload-related clinician stress levels in general hospital consultation liaison psychiatry services during the COVID-19 pandemic in England and Ireland. Short report

OBJECTIVE

To explore workload-related stress levels experienced by consultation liaison psychiatry (CLP) staff in England and Ireland, and factors relevant to such a burden, during the COVID-19 pandemic.

METHODS

Data were obtained for England and Ireland from a European survey among CLP services in general hospitals spread via CLP networks (11th June - 3rd October 2021). The heads of respective CLP services in general hospitals responded on behalf of each service, on 100 CLP hospital staff in total.

DEPENDENT VARIABLE

workload-related stress levels in CLP services due to COVID-19 (0-10 point scale).

INDEPENDENT VARIABLES

hospital size, CLP service size, degree of hospital involvement in COVID-19-related care, and the number of support options available to hospital staff. Spearman's rho correlation analyses were performed.

RESULTS

There was a significant association between the hospital's involvement in COVID-19-related care and workload-related stress levels as reported by CLP staff: r(22) = 0.41, p = 0.045, R2 = 0.17. There were no significant associations between workload-related stress levels and other variables including staff support (p = 0.74).

CONCLUSION

Our findings suggest that perceived workload-related stress levels of CLP staff during the COVID-19 pandemic can be an indicator of COVID-19 involvement of the hospitals. Staff support seemed not to alleviate work stress in the context of the pandemic. Healthcare policies should improve working conditions for CLP hospital staff that play an essential role from a population health perspective. Rigorous measures may be needed to ensure mental healthcare provision remains tenable and sustainable in the long term.

UK medical students' mental health during the COVID-19 pandemic: a qualitative interview study

OBJECTIVES

To understand the impact of COVID-19 on medical students with mental health problems.

DESIGN

Qualitative study employing in-depth semistructured interviews with medical students which were analysed using reflexive thematic analysis.

SETTING AND PARTICIPANTS

A purposive sample of 20 students originating from 8 geographically spread UK medical schools were selected, representing various mental health issues and demographic characteristics.

RESULTS

Three themes were identified: (1) medical schools' response to the pandemic-schools increased awareness-raising of mental health support and increased flexibility in regards to academic requirements; (2) disruption to the medical degree-COVID-19 brought change and uncertainty to medical education and missed learning opportunities reduced students' confidence and (3) psychological consequences of the pandemic-COVID-19 had a negative impact on mental health, most notably raising stress and anxiety but also triggering new or existing conditions.

CONCLUSIONS

While there were many negative aspects of the pandemic for medical students experiencing mental ill health, there were also positives. Students felt that the increased focus on mental health support during the pandemic had reduced stigma towards mental health. Given stigma has been identified as a key barrier for help-seeking in medical students, future research should investigate the longer-term impacts of the pandemic and whether medical students are more likely to seek help for mental health difficulties postpandemic.

'Now I can train myself to be with death': a phenomenological study with young doctors in care homes supported by a palliative care unit during the second wave of the pandemic in Italy

OBJECTIVE

During the second wave of the COVID-19 pandemic, one of the organisational strategies established by the Italian National Health System was the special units for continuity of care (SUCCs). In the province of Ravenna, those units enrolled novice doctors to care for elderly patients with COVID-19 in care homes (CHs). The local palliative care (PC) unit decided to offer consultations and support to them. This study aimed to comprehend the experience of young doctors who asked for consultations when facing, during their first early years of practice, complex situations.

DESIGN

We conducted a qualitative study employing a phenomenological approach and in-depth interviews.

PARTICIPANTS

We involved 10 young doctors who worked in Italian SUCC during the pandemic and used a PC consultation support service.

RESULTS

What describes our participants' experience is related to four main themes: (1) reducing distances, (2) perceiving medical futility and improvising, (3) being supported to learn how to be with death and (4) narrowed timing to humanise care. The pandemic was, for our participants, a moment of reflection and critique on the skills acquired during the university course. It was a strong experience of human and professional growth that helped them reshape and deepen their role and skills, incorporating the approach of PC into their professional identity.

CONCLUSIONS

Integration between specialists and young doctors with an early entry into the workforce during the pandemic in CHs set out a 'shift' to a proactive and creative approach through a new awareness of professional and personal roles in doctor-patient relations. The continuity of care models should be rethought by integrating CHs and PC. Adequate PC training for young doctors (at pregraduate and postgraduate levels) can change doctors' vision and daily practice in assisting patients at the end of life.