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Erschens R, Skrypski I, Festl-Wietek T, Herrmann-Werner A, Adam SH, Schröpel C, Nikendei C, Zipfel S, Junne F. Insights into discrepancies in professional identities and role models in undergraduate medical education in the context of affective burden. Front Psychiatry 2024; 15:1358173. [PMID: 38757136 PMCID: PMC11097199 DOI: 10.3389/fpsyt.2024.1358173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/22/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction International evidence strongly suggests that medical students are at high risk of mental health problems. This distress, which can be mediated by a variety of individual, interpersonal and contextual factors within the curriculum, can be mitigated by effective coping strategies and interventions. Central to this discourse is the recognition that the challenges of professional identity formation can contribute significantly to medical students' distress. The focus of our study is therefore to examine discrepancies in professional identities and role models in undergraduate medical education in relation to affective burden. Methods Medical students at different stages of university education and high school graduates intending to study medicine were surveyed in a cross-sectional study. The study employed Osgood and Hofstätter's polarity profile to evaluate the self-image of participants, the image of an ideal and real physician, and their correlation with depression (PHQ-9) and anxiety (GAD-7). Results Out of the 1535 students recruited, 1169 (76.2%) participated in the study. Students rated their self-image as somewhere between a more critical real image of physicians and a more positive ideal image. Medical students at all training levels consistently rated the ideal image as remaining constant. Significant correlations were found between the professional role models of medical students and affective symptoms, particularly for the discrepancy between the ideal image of a physician and their self-image. Furthermore, 17% and nearly 15% reported significant symptoms of depression and anxiety, respectively. Discussion Our study adds to the growing body of knowledge on professional identity formation in medicine and socialisation in the medical environment. The study highlights the importance of discrepancies between self-image and ideal image in the experience of depressive and anxiety symptoms. Primary prevention-oriented approaches should incorporate these findings to promote reflective competence in relation to professional role models and strengthen the resilience of upcoming physicians in medical training.
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Affiliation(s)
- Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Isabelle Skrypski
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education, University of Tübingen, Tübingen, Germany
| | - Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Tübingen Institute for Medical Education, University of Tübingen, Tübingen, Germany
| | - Sophia Helen Adam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Carla Schröpel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Christoph Nikendei
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Deanery of Students’ Affairs, University’s Faculty of Medicine, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University Magdeburg, University Hospital Magdeburg, Magdeburg, Germany
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Laird-Gion JN, Garabedian LF, Conrad R, Shaffer AC, Witkowski ML, Mateo CM, Jones DS, Hundert E, Kasper J. "The Water in Which We Swim:" A Unique, Post-Clerkship Multidisciplinary Course. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241232184. [PMID: 38390256 PMCID: PMC10883117 DOI: 10.1177/23821205241232184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To improve patient outcomes and promote health equity, medical students must be taught not only biomedicine, but also the social sciences to understand the larger contexts in which patients live and health care operates. Yet, most undergraduate medical education does not explicitly cover these topics in a required, longitudinal curriculum. METHODS In January 2015 at Harvard Medical School, we created a two-part sequence (pre- and post-clerkship) of required, 4-week multidisciplinary courses-"Essentials of the Profession I and II"-to fill this gap. "Essentials of the Profession II (EOP2)" is an advanced social sciences course anchored in patient narratives and the lived experiences of students and includes clinical epidemiology and population health, healthcare delivery and leadership, health policy, medical ethics and professionalism, and social medicine that engages students to conduct structural analyses to be effective healers, advocates, and leaders. RESULTS Per student course evaluations, the overall course rating was 1.7 (SD 0.9, 1 = excellent and 5 = poor); its overall rating has improved over time; and it has scored well even when run virtually. It was rated highly in application of critical thinking, integration of the disciplines, and relevance for clinical work. Qualitative analyses of student responses revealed the following key course strengths: breadth of topics, teaching faculty and guest speakers, and small group discussions. The weaknesses included workload, lack of diversity of opinions, repetition, and time spent in lectures. CONCLUSIONS We argue that EOP2 is "essential" for post-clerkship medical education. It offers an opportunity to re-ignite and enhance humanism and activism; remind students why they chose the medical profession; equip them with frameworks and toolkits to help them to overcome challenges; and devise solutions to improve health care and patient outcomes that are applicable to their future training and ongoing practice of medicine.
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Affiliation(s)
- Jessica N Laird-Gion
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura F Garabedian
- Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Rachel Conrad
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam C Shaffer
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary L Witkowski
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Camila M Mateo
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - David S Jones
- Harvard Medical School, Boston, MA, USA
- Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
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Park J, Hwang J, Lim Y, Heo J, Kim WH. Exploring the interest of medical students in global health in South Korea: Does taking a global health course matter? BMC MEDICAL EDUCATION 2023; 23:750. [PMID: 37821889 PMCID: PMC10566093 DOI: 10.1186/s12909-023-04703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Prioritizing global health is important for positive health outcomes. Doctors play a pivotal role in addressing health issues that they need to recognize the importance of global health practice. However, medical education in global health is still in its early stages in many countries, including South Korea. METHODS This study is a quantitative cross-sectional study. Medical students were recruited from all 40 Korean medical schools and data collection was conducted in 2021. Stratified proportional quota sampling was employed as the sampling method. The study examined medical students' interest in global health as the dependent variable. Independent variables included whether individuals had taken global health courses as part of their medical curriculum, while covariates included student background and institutional factors. Logistic regression was used to determine if taking a global health class was associated with global health interests. RESULTS The study included 2450 participants and almost 32% of medical students (n = 781) were interested in global health. Taking global health classes in school was associated with a higher likelihood of developing an interest in global health (OR: 1.29, 95% CI: 1.00-1.67). The likelihood of being interested in global health decreased across the academic year (OR: 0.70, 95% CI: 0.53-0.94). Individuals in graduate entry programs were associated with an interest in global health (OR: 1.32, 95% CI: 1.01-1.72). CONCLUSION This study provides the first comprehensive nationwide assessment of medical students' perspectives on global health education in South Korea. The findings underscore the importance of early and sustained exposure to global health topics in medical education in fostering interest in global health. These results can serve as valuable evidence for medical educators seeking to integrate global health education into their curricula.
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Affiliation(s)
- Jayoung Park
- Department of Human Systems Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Ihwajang-gil 71, Jongno-gu, Seoul, Republic of Korea
| | - Jongnam Hwang
- Division of Social Welfare & Health Administration, Wonkwang University, 460 Iksandae-ro, Iksan, Jeonbuk, Republic of Korea.
| | - Yeji Lim
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Ihwajang-gil 71, Jongno-gu, Seoul, Republic of Korea
| | - Jongho Heo
- Department of Human Systems Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Ihwajang-gil 71, Jongno-gu, Seoul, Republic of Korea.
- National Assembly Futures Institute, 1, Uisadang-daero, Yeongdeungpo-gu, Seoul, Republic of Korea.
| | - Woong-Han Kim
- Department of Human Systems Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Ihwajang-gil 71, Jongno-gu, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Cañadas GR, Membrive-Jiménez MJ, Martos-Cabrera MB, Albendín-García L, Velando-Soriano A, Cañadas-De la Fuente GA, De la Fuente-Solana EI. Burnout and Professional Engagement during the COVID-19 Pandemic among Nursing Students without Clinical Experience: A Cross-Sectional Study. J Clin Med 2023; 12:5144. [PMID: 37568547 PMCID: PMC10420274 DOI: 10.3390/jcm12155144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
Burnout affects many healthcare professionals, especially nurses, causing serious health problems and disrupting the work environment. Academic burnout may also be experienced, leading students to feel unable to cope with their education. As a result, they may lose interest and even consider abandoning their studies. Hence, burnout syndrome can affect both the mental health and the professional future of those affected. To evaluate academic burnout in nursing students who had no clinical experience before starting their practical training, a cross-sectional study involving 212 third-year nursing students at the University of Granada was conducted. Data were collected using the Granada Burnout Questionnaire, the Utrecht Work Engagement Scale, the NEO Five-Factor Inventory, the Hospital Anxiety and Depression Scale, and the Fear of CoronaVirus-19 Scale. High levels of burnout were present in 37.8% of the students. Moreover, 21.5% and 8.7% had borderline cases of anxiety or depression, respectively. Another 30.8% and 9.2%, respectively, were considered likely to present these conditions. According to the predictive models of burnout dimensions obtained, neuroticism is a predictor of all three burnout dimensions. Furthermore, anxiety, depression, extraversion, responsibility and engagement are predictors of some dimensions of the syndrome. Many nursing students present high levels of burnout, which is related to certain personality variables and to the presence of anxiety and/or depression. The level of professional engagement is inversely associated with the impact of burnout. The participants in this study have normalised their return to the pre-pandemic study routine (in-person classes), and fear of COVID-19 was not a significant predictor of any dimension of burnout.
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Affiliation(s)
- Gustavo R. Cañadas
- Department of Didactic of Mathematics, Faculty of Education Science, University of Granada, Campus Universitario de Cartuja s/n, 18011 Granada, Spain;
| | - María José Membrive-Jiménez
- Faculty of Health Sciences, University of Granada, Av. Ilustración 60, 18016 Granada, Spain; (M.J.M.-J.); (G.A.C.-D.l.F.)
| | - María Begoña Martos-Cabrera
- San Cecilio Clinical University Hospital, Andalusian Health Service, Av. del Conocimiento s/n, 18016 Granada, Spain; (M.B.M.-C.); (A.V.-S.)
| | - Luis Albendín-García
- Casería de Montijo Health Center, Granada-Metropolitan Health District, Andalusian Health Service, Calle Virgen de la Consolación 12, 18015 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain
| | - Almudena Velando-Soriano
- San Cecilio Clinical University Hospital, Andalusian Health Service, Av. del Conocimiento s/n, 18016 Granada, Spain; (M.B.M.-C.); (A.V.-S.)
| | - Guillermo A. Cañadas-De la Fuente
- Faculty of Health Sciences, University of Granada, Av. Ilustración 60, 18016 Granada, Spain; (M.J.M.-J.); (G.A.C.-D.l.F.)
- Brain, Mind and Behaviour Research Center (CIMCYC), University of Granada, Campus Universitario de Cartuja s/n, 18011 Granada, Spain
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Muaddi MA, El-Setouhy M, Alharbi AA, Makeen AM, Adawi EA, Gohal G, Alqassim AY. Assessment of Medical Students Burnout during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3560. [PMID: 36834259 PMCID: PMC9964633 DOI: 10.3390/ijerph20043560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
This study estimated the prevalence of burnout and its determinants among medical students at Jazan University during the COVID-19 pandemic. A total of 444 medical students completed an online survey containing the Maslach burnout inventory. The prevalence of burnout was 54.5%. Burnout reached its peak during the fourth year whereas it was the lowest in the internship year. Being a resident in mountain areas, being delayed in college-level, being divorced, and having divorced parents were all associated with an increased risk of burnout. During their time at medical school, students generally showed a trend of consistently high scores in the personal accomplishment subscale, a decreasing trend in the emotional exhaustion subscale, and an increasing trend in the depersonalization subscale. The most important predictive factor was having separated parents. Perceived study satisfaction appeared to be a significant protective factor in a dose-response manner. These findings suggest that burnout among medical students during the COVID-19 pandemic is a concern that should be monitored and prevented.
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Affiliation(s)
- Mohammed A. Muaddi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Maged El-Setouhy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
- Department of Emergency Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Abdullah A. Alharbi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Anwar M. Makeen
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Essa A. Adawi
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Gassem Gohal
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Ahmad Y. Alqassim
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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Stoutenberg M, Lewis LK, Jones RM, Portacio F, Vidot DC, Kornfeld J. Assessing the current and desired levels of training and applied experiences in chronic disease prevention of students during medical school. BMC MEDICAL EDUCATION 2023; 23:54. [PMID: 36690998 PMCID: PMC9872306 DOI: 10.1186/s12909-023-04044-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/19/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Chronic diseases account for approximately 70% of deaths in the U.S. annually. Though physicians are uniquely positioned to provide behavior change counseling for chronic disease prevention, they often lack the necessary training and self-efficacy. This study examined medical student interest in receiving chronic disease prevention training as a formal part of their education as part of an effort to enhance their ability to provide guidance to patients in the future. METHODS A 23-question, online survey was sent to all undergraduate medical students enrolled in a large medical education program. The survey assessed medical student interest in receiving training related to chronic disease prevention. Survey topics included student awareness of primary prevention programs, perceived importance of receiving training and applied experience in chronic disease prevention, and preferences for how and when to receive this training. RESULTS Of 793 eligible medical students, 432 completed the survey (54.5%). Overall, 92.4% of students reported receiving formal training in physical activity, public health, nutrition, obesity, smoking cessation, and chronic diseases was of "very high" or "high" importance. Despite this level of importance, students most frequently reported receiving no or 1-5 h of formal training in a number of topics, including physical activity (35.4% and 47.0%, respectively) and nutrition (16.9% and 56.3%, respectively). The level of importance given to public health training was significantly greater across degree type (p = 0.0001) and future specialty (p = 0.03) for MD/MPH students and those interested in primary care, respectively. CONCLUSIONS While medical students perceive chronic disease prevention as an important topic, most reported receiving little to no formal training. To address the growing prevalence of chronic disease across our society, programs schools should place greater emphasis on integrating training in physical activity, nutrition, and obesity-related content into the medical education curriculum.
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Affiliation(s)
- Mark Stoutenberg
- Department of Kinesiology, College of Public Health, Temple University, 237 Pearson Hall, 1800 North Broad Street, Philadelphia, PA, USA.
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Lauren K Lewis
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
- Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - Francia Portacio
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
- Combined Degree and Physician Scholars Program Office, University of Pennsylvania, Philadelphia, PA, USA
| | - Denise C Vidot
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Julie Kornfeld
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
- School of Public Health, Columbia University, New York, NY, USA
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Sra M, Gupta A, Jaiswal A, Yadav K, Goswami A, Goswami K. Willingness of medical students to volunteer during the Covid-19 pandemic: Assessment at a tertiary care hospital in India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2022; 35:247-251. [PMID: 36715037 DOI: 10.25259/nmji_104_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The involvement of medical students in strategies to control Covid-19 might be considered to cope with the shortage of healthcare workers. We assessed the knowledge about Covid-19, willingness to volunteer, potential areas of involvement and reasons for hesitation among medical students towards volunteering. Methods We did this cross-sectional study among undergraduate students at a tertiary care teaching hospital in New Delhi. We used a web-based questionnaire to elicit demographic information, knowledge of Covid-19, willingness to volunteer and reasons deterring them from working during the Covid-19 pandemic, and self-declared knowledge in six domains. Results A total of 292 students participated in the study with a mean (SD) age of 19.9 (3.1) years. The mean (SD) knowledge score of Covid-19 was 6.9 (1.1) (maximum score 10). Knowledge score was significantly different among preclinical (6.5), paraclinical (7.18) and clinical groups (7.03). Almost three-fourth (75.3%) participants were willing to volunteer in the Covid-19 pandemic, though 67.8% had not received any training in emergency medicine or public health crisis management. Willingness to work was maximum in areas of social work and indirect patient care (62.3% each). Lack of personal protective equipment was cited as a highly deterring factor for volunteering (62.7%) followed by fear of transmitting the infection to family members (45.9%), fear of causing harm to the patient (34.2%) and the absence of available treatment (22.2%). Conclusions A majority of the students were willing to volunteer even though they had not received adequate training. Students may serve as an auxiliary force during the pandemic, especially in non-clinical settings.
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Affiliation(s)
- Manraj Sra
- Undergraduate students All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Amulya Gupta
- Undergraduate students All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Anil Goswami
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kiran Goswami
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Ding M, Koppula S, Szafran O, Au L, Babenko O. Mindsets of Early-Career Family Physicians Trained in Competency-Based Education. PRIMER (LEAWOOD, KAN.) 2021; 5:39. [PMID: 34841214 PMCID: PMC8612592 DOI: 10.22454/primer.2021.389603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The objective of this study was to examine the mindsets (mastery, performance approach, performance avoidance) of early-career family physicians following graduation from a competency-based education residency program. METHODS This was a longitudinal, cohort, survey study of family medicine residents at a large Canadian university. The 2015-2017 cohort of family medicine residents was surveyed at three time points: (1) at the end of residency training; (2) at 1 year in clinical practice; and (3) at 3 years in clinical practice. We used Baranik et al's instrument to measure three types of mindsets. We performed descriptive and multivariate analyses using SPSS 26.0 software. RESULTS Irrespective of the time in practice, mean scores were the highest on the mastery mindset and the lowest on the performance avoidance mindset measures (P<.001). Over time, the mastery mindset scores tended to decrease (P=.04). CONCLUSION Family physicians trained in competency-based education continued to be mastery-oriented in the first 3 years of clinical practice. This finding is reassuring given that the mastery mindset is associated with professional well-being and long-term success. Nonetheless, because mastery mindset scores appeared to decrease over time, residency programs need to ensure graduating residents are equipped with knowledge and tools to remain mastery-oriented throughout the course of their professional careers.
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Affiliation(s)
- Mao Ding
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Sudha Koppula
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Olga Szafran
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Lillian Au
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Oksana Babenko
- Department of Family Medicine, University of Alberta, Edmonton, Canada
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Lessons from Asylum Seekers: How Forensic Medical Evaluations Can Teach Us Things We Didn't Learn in Medical School. J Gen Intern Med 2021; 36:2121-2122. [PMID: 32875493 PMCID: PMC8298660 DOI: 10.1007/s11606-020-06157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
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Mercadante SF, Goldberg LA, Divakaruni VL, Erwin R, Savoy M, O'Gurek D. Impact of Student-Run Clinics on Students' Attitudes Toward People Experiencing Homelessness. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2021; 5:19. [PMID: 34286222 DOI: 10.22454/primer.2021.489756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction Student-run clinics can supplement medical education by exposing students to diverse clinical scenarios and collaborating with underresourced populations. We examined the impact of volunteering at THRIVE, a student-run bridge clinic located within sheltered housing for individuals with substance use disorder, on students' attitudes toward people experiencing homelessness (PEH). Methods This cohort study analyzed pre- and postsurvey matched responses from nonvolunteer and volunteer first-year medical students utilizing the Health Professional Attitudes Towards the Homeless (HPATHI) tool, totaled into three subcategories: Cynicism, Social Advocacy, and Personal Advocacy. We evaluated the association between change in scores and volunteering utilizing Student t tests and adjusting for participant characteristics using multivariable regression analysis. Results We received 106 responses (53% response rate); 58 students (55%) volunteered at the clinic and were mostly female (62%), White (52%), and had previous experience working with PEH (71%). The mean change in Personal Advocacy scores was higher for volunteers compared to nonvolunteers, even when adjusting for respondent characteristics (P=.02). Additionally, students who held a prior advanced degree and/or current enrollment in the master of bioethics program (Higher Education Students) had a positive association with change in Personal Advocacy scores (P=.02). Conclusion Volunteering at the THRIVE Clinic appears to impact the Personal Advocacy scores of medical students. This suggests that interacting with PEH early in students' career may be associated with a commitment to working with this population. However, our study has multiple limitations, including self-selection bias, limited sample size, and unclear permanence of students' attitudes over time. Further studies of this cohort could help clarify the significance and permanence of volunteering in student-run clinics.
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Affiliation(s)
| | - Leah A Goldberg
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | | | - Ryan Erwin
- Division of Internal Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Margot Savoy
- Department of Family and Community Medicine, Temple University Health System, Philadelphia, PA
| | - David O'Gurek
- Department of Family and Community Medicine, Temple University Health System, Philadelphia, PA
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Woolley T, Ross S, Larkins S, Sen Gupta T, Whaleboat D. "We learnt it, then we lived it": Influencing medical students' intentions toward rural practice and generalist careers via a socially-accountable curriculum. MEDICAL TEACHER 2021; 43:93-100. [PMID: 33016806 DOI: 10.1080/0142159x.2020.1817879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The James Cook University (JCU) medical school has a mission to produce graduates committed to practising with underserved populations. This study explores the views of final-year students regarding the influence of the JCU medical curriculum on their self-reported commitment to socially-accountable practice, intentions for rural practice, and desired postgraduate training pathway. METHODS Cross-sectional survey of final year JCU medical students (n = 113; response rate = 65%) to determine whether their future career directions (intentions for future practice rurality and postgraduate specialty training pathway) are driven more by altruism (commitment to socially accountable practice/community service) or by financial reward and/or prestige. RESULTS Overall, 96% of responding students reported their JCU medical course experiences had cultivated a greater commitment towards 'socially-accountable' practice. A commitment to socially-accountable practice over financial reward and/or prestige was also significantly associated with preferring to practise Medicine in non-metropolitan areas (p = 0.036) and intending to choose a 'generalist' medical discipline (p = 0.003). CONCLUSIONS The findings suggest the JCU medical curriculum has positively influenced the commitment of its graduating students towards more socially accountable practice. This influence is a likely result of pre-clinical teachings around health inequalities and socially-accountable medical practice in combination with real-world, immersive experiences on rural and international placements.
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Affiliation(s)
- Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Simone Ross
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Donald Whaleboat
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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12
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Gilligan C, Loda T, Junne F, Zipfel S, Kelly B, Horton G, Herrmann-Werner A. Medical identity; perspectives of students from two countries. BMC MEDICAL EDUCATION 2020; 20:420. [PMID: 33172441 PMCID: PMC7654572 DOI: 10.1186/s12909-020-02351-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The development of professional identity is a fundamental element of medical education. There is evidence that in Germany, students' perceptions of the ideal and real doctor differ, and that of themselves as physicians falls between these constructs. We sought to compare students' perceptions of themselves, the ideal doctor, and the 'real' doctor and investigate differences from first to final year in the relationships between these constructs, as well as differences between Australian and German cohorts. METHOD Students in the first and final years of their medical program at one Australian and one German university were invited to complete the Osgood and Hofstatter polarity profile, involving the description of their mental image of the ideal and real doctor, and the doctor they hope to become, with adjectives provided. RESULTS One hundred sixty-seven students completed the survey in Australia (121 year 1, 46 year 5) and 188 in Germany (164 year 1, 24 year 6). The perception of the ideal doctor was consistent across all respondents, but that of the real doctor and self-image differed between country and year. Differences existed between country cohorts in perceptions of 'confidence', 'strength', 'capability' and 'security'. CONCLUSIONS The pattern previously reported among German students was maintained, but a different pattern emerged among Australian students. Differences between countries could reflect cultural differences or variations in the overt and hidden curricula of medical schools. Some of the constructs within the profiles are amenable to educational interventions to improve students' confidence and sense of capability.
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Affiliation(s)
- Conor Gilligan
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Teresa Loda
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany.
- School of Medicine, University of Tuebingen, Tuebingen, Germany.
| | - Florian Junne
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany
- School of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany
- School of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Graeme Horton
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Anne Herrmann-Werner
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany
- School of Medicine, University of Tuebingen, Tuebingen, Germany
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13
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Pinto-Powell R, Lahey T. Just a Game: the Dangers of Quantifying Medical Student Professionalism. J Gen Intern Med 2019; 34:1641-1644. [PMID: 31147979 PMCID: PMC6667566 DOI: 10.1007/s11606-019-05063-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/16/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Abstract
A medical student on her internal medicine clerkship says her numerical medical professionalism grade was "just a game." Building on this anecdote, we suggest there is good reason to believe that numerical summative assessments of medical student professionalism can, paradoxically, undermine medical student professionalism by sapping internal motivation and converting conversations about core professional values into just another hurdle to residency. We suggest better ways of supporting medical student professional development, including a portfolio comprised of written personal reflection and periodic 360° formative assessment in the context of longitudinal faculty coaching.
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Affiliation(s)
- Roshini Pinto-Powell
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. .,Department of Medical Education, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Timothy Lahey
- Larner College of Medicine, University of Vermont, Burlington, VT, USA.,The University of Vermont Medical Center, Burlington, VT, USA
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14
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Pisaniello MS, Asahina AT, Bacchi S, Wagner M, Perry SW, Wong ML, Licinio J. Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review. BMJ Open 2019; 9:e029980. [PMID: 31270123 PMCID: PMC6609129 DOI: 10.1136/bmjopen-2019-029980] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES With the high and rising total cost of medical school, medical student debt is an increasing concern for medical students and graduates, with significant potential to impact the well-being of physicians and their patients. We hypothesised that medical student debt levels would be negatively correlated with mental health and academic performance, and would influence career direction (ie, medical specialty choice). DESIGN We performed a systematic literature review to identify articles that assessed associations between medical student mental health, academic performance, specialty choice and debt. The databases PubMed, Medline, Embase, Scopus and PsycINFO were searched on 12 April 2017, for combinations of the medical subject headings Medical Student and Debt as search terms. Updates were incorporated on 24 April 2019. RESULTS 678 articles were identified, of which 52 met the inclusion criteria after being reviewed in full text. The majority of studies were conducted in the USA with some from Canada, New Zealand, Scotland and Australia. The most heavily researched aspect was the association between medical student debt and specialty choice, with the majority of studies finding that medical student debt was associated with pursuit of higher paying specialties. In addition, reported levels of financial stress were high among medical students, and correlated with debt. Finally, debt was also shown to be associated with poorer academic performance. CONCLUSIONS Medical student debt levels are negatively associated with mental well-being and academic outcomes, and high debt is likely to drive students towards choosing higher paying specialties. Additional prospective studies may be warranted, to better understand how educational debt loads are affecting the well-being, career preparation and career choices of physicians-in-training, which may in turn impact the quality of care provided to their current and future patients.
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Affiliation(s)
| | - Adon Toru Asahina
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Morganne Wagner
- State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Seth W Perry
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Ma-Li Wong
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Julio Licinio
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, New York, USA
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15
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Mitchell JA, Rodríguez JE. Commentary on “What Attracts Medical Students to Primary Care? A Nominal Group Evaluation”. South Med J 2019; 112:83-84. [DOI: 10.14423/smj.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Yen AJ, Webb EM, Jordan EJ, Kallianos K, Naeger DM. The Stability of Factors Influencing the Choice of Medical Specialty Among Medical Students and Postgraduate Radiology Trainees. J Am Coll Radiol 2018; 15:886-891. [DOI: 10.1016/j.jacr.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/02/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
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17
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Affiliation(s)
- Hilary Neve
- Plymouth University; Peninsula Schools of Medicine and Dentistry; School of Medicine; Plymouth UK
| | - Tracey Collett
- Plymouth University; Peninsula Schools of Medicine and Dentistry; School of Medicine; Plymouth UK
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18
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Moser EM, Fazio SB, Packer CD, Glod SA, Smith CD, Alguire PC, Huang GC. SOAP to SOAP-V: A New Paradigm for Teaching Students High Value Care. Am J Med 2017; 130:1331-1336.e2. [PMID: 28778492 DOI: 10.1016/j.amjmed.2017.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | - Cynthia D Smith
- American College of Physicians, Philadelphia, Pa; University of Pennsylvania, Philadelphia
| | - Patrick C Alguire
- American College of Physicians, Philadelphia, Pa; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa
| | - Grace C Huang
- Harvard Medical School, Boston, Mass; Carl J. Shapiro Institute for Education and Research at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
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Karunakaran I, Thirumalaikolundusubramanian P, Nalinakumari SD. A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges. ANATOMICAL SCIENCES EDUCATION 2017; 10:433-443. [PMID: 28165673 DOI: 10.1002/ase.1679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 11/08/2016] [Accepted: 12/22/2016] [Indexed: 05/17/2023]
Abstract
Professionalism and ethics have gained widespread recognition as competencies to be fulfilled, taught, and assessed within medical education. The role of the anatomy course in developed nations has evolved over time and now encompasses multiple domains, including knowledge, skills, and the inculcation of professionalism and ethics. The Medical Council of India recently recommended the integration of professionalism teaching in undergraduate medical curricula. The authors investigated whether the initial orientation lectures and instructions given by faculty at the outset of undergraduate medical anatomy courses throughout India served a "hidden curriculum" regarding professionalism practices, and whether these orientation messages could serve as an early exposure to medical professionalism and ethics for medical students. An online survey was carried out among 102 anatomy faculty members across India requesting details about specific professionalism protocols and instructions regarding behavior in the dissection hall that are routinely given to preclinical students, as well as the importance that they placed on professional behavior. It was found that most faculty members regularly instruct students regarding expected behavior during the anatomy course, including dissection practices. These instructions stress attributes of professionalism like humanism, accountability, and honesty. However, there needs to be a more concentrated effort by educators to prohibit such unprofessional practices like dissection hall photography, and better information is required regarding biomedical waste disposal. Despite the absence of clear guidelines for professionalism teaching in medical education in India, the existing framework of anatomy education provides an opportunity to introduce the concept of professionalism to the first-year medical student. This opportunity may provide an early foundation for designing a professionalism-integrated curriculum. Anat Sci Educ 10: 433-443. © 2017 American Association of Anatomists.
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Affiliation(s)
- Ilavenil Karunakaran
- Department of Anatomy, Chennai Medical College Hospital and Research Centre, Irungalur, Tiruchirapalli, Tamil Nadu, India
| | | | - Sheela Das Nalinakumari
- Department of Anatomy, Chennai Medical College Hospital and Research Centre, Irungalur, Tiruchirapalli, Tamil Nadu, India
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20
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Evans DV, Krasin B, Brown K, Dobie S, Kost A. Student Perceptions About Benets From an Extracurricular Curriculum: A Qualitative Study of the Underserved Pathway. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2017; 1:13. [PMID: 32944699 DOI: 10.22454/primer.2017.153424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction Too few medical graduates choose to care for underserved populations. This qualitative study explores medical student perceptions of the benefits of participating in the Underserved Pathway (UP), a 4-year extracurricular program designed to nurture interest in, and develop skills to serve vulnerable populations. Methods Fourteen of 28 graduating students in the class of 2013 who completed the UP were interviewed. Using conventional qualitative content analysis, an iterative process was used to code transcriptions until there was high concordance among the assigned codes. The research team analyzed the data for common themes, theme saturation, and unique perspectives. Results Four major thematic areas emerged: 1) the underserved curriculum scaffold, 2) influence on career choice, 3) influence on residency choice, and 4) capacity to match. Of all participants, 78.6% thought the UP influenced their career choice, 64.3% stated the UP played a role in residency choice and rank, and 85.7% thought participation in the UP would improve match success. No single curricular component of the UP was individually responsible for career or specialty choice, or as being most useful to student understanding of the underserved. Conclusions Students noted that participation in the UP provided them with a scaffold to support their interest in underserved careers, and influenced their specialty and residency choice. They also perceived it as making them more competitive as residency applicants. This study provides medical educators with insight into the importance of building robust frameworks, even extracurricular ones, to support student interests in serving vulnerable communities.
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Affiliation(s)
- David V Evans
- Department of Family Medicine, University of Washington
| | | | - Kevin Brown
- University of California at Irvine, Psychiatry Residency
| | - Sharon Dobie
- Department of Family Medicine, University of Washington
| | - Amanda Kost
- Department of Family Medicine, University of Washington School of Medicine
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21
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Choosing surgery as a career: Early results of a longitudinal study of medical students. Surgery 2017; 161:1683-1689. [DOI: 10.1016/j.surg.2016.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/28/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022]
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22
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Brown RMA, Donaldson JF, Warne-Griggs MD, Bagby Stone S, Campbell JD, Hoffman KG. Journeying to the White Coat Ceremony: A description of the people, situations and experiences that inform student visions of the physician they hope to become. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2017; 4:2382120517725506. [PMID: 29349340 PMCID: PMC5736282 DOI: 10.1177/2382120517725506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
Little is known about the experiences that influence entering medical students' internal concepts of themselves as future physicians. During orientation to medical school, students were asked to write stories in response to the cue, "Tell a story about a person or experience that inspired you to consider a career of service in medicine." Qualitative methodology was employed to analyze 190 student stories. Thematic analysis identified descriptive details about content and allowed comparison between the students' and School's expectations. Inspirational settings, contexts, and individuals were identified. Nine different inspirational events were described. Student and School expectations for the kinds of physicians they hoped to become were generally consistent. The study demonstrates that students do indeed bring to medical school visions of the kinds of physicians they hope to become. Linking that vision with medical school activities including the White Coat Ceremony provides a bridge between medical school and students' earlier lives, thus explicitly linking orientation to professional formation.
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Affiliation(s)
- Rachel MA Brown
- College of Medicine, Central Michigan University, Mount Pleasant MI, USA
| | - Joe F Donaldson
- Department of Education, University of Missouri, Columbia MO, USA
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23
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Phillips JP, Wilbanks DM, Salinas DF, Doberneck DM. Educational Debt in the Context of Career Planning: A Qualitative Exploration of Medical Student Perceptions. TEACHING AND LEARNING IN MEDICINE 2016; 28:243-51. [PMID: 27152504 DOI: 10.1080/10401334.2016.1178116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Phenomenon: Medical students in the United States face increasing educational debt because medical education costs have risen while public investment in higher education has declined. Contemporary students borrow more money and accumulate debt far surpassing that of previous generations of physicians, and both interest rates and terms of loan repayment have changed significantly in the last decade. As a result, the experiences of medical students differ from the experiences of physician educators. Little is known about how contemporary medical students view their debt in the context of career planning. Understanding contemporary U.S. medical students' lived experiences of educational debt is important, because high debt levels may affect medical students' well-being and professional development. APPROACH The study's purpose was to explore contemporary students' views of their debt in the context of career planning. In 2012, 2nd-year medical students enrolled in a health policy course at one medical school were invited to write an essay about how debt influences their career choices. The authors analyzed 132 essays using immersion and crystallization and iterative, team-based coding. Code-recode strategies, member checking, and reflexivity ensured validity and rigor. FINDINGS Three themes emerged about the meaning of debt: debt symbolizes lack of social investment, debt reinforces a sense of entitlement, and debt is a collective experience. Four approaches to debt management emerged: anticipation, avoidance, acceptance, and disempowerment. Insights: Medical students' views of debt are more complex than previously reported. Medical educators should recognize that many students experience debt as a stressor, acknowledge students' emotions about debt, and invite discussion about the culture of entitlement in medical education and how this culture affects students' professionalism. At the same time, educators should emphasize that students have many repayment options and that regardless of specialty choice, most physicians repay their debts without significant difficulty. Further exploration is needed of the relationships between the amount of debt owed, students' attitudes toward their debt, and other student characteristics. Because students experience debt in a range of ways, more nuanced approaches to understanding and reframing student perceptions of debt are necessary.
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Affiliation(s)
- Julie P Phillips
- a Department of Family Medicine , College of Human Medicine, Michigan State University , East Lansing , Michigan , USA
| | - Deana M Wilbanks
- b Office of Student Affairs and Services, College of Human Medicine, Michigan State University , East Lansing , Michigan , USA
| | - Diana F Salinas
- c College of Human Medicine, Michigan State University , East Lansing , Michigan , USA
| | - Diane M Doberneck
- d National Collaborative for the Study of University Engagement , Michigan State University , East Lansing , Michigan , USA
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24
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Rabow MW, Lapedis M, Feingold A, Thomas M, Remen RN. Insisting on the Healer's Art: The Implications of Required Participation in a Medical School Course on Values and Humanism. TEACHING AND LEARNING IN MEDICINE 2016; 28:61-71. [PMID: 26787086 DOI: 10.1080/10401334.2015.1107485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
THEORY Elective courses, by definition, allow medical students to self-select for participation in the class. In a small-group learning setting, students uninterested or not ready for a particular learning topic might change the educational experience ("poison the well") for those students most interested in the topic. It is not known how medical students required to take a course in humanism (that they otherwise would not have elected to take) might be impacted by the course or how their presence might affect students originally interested in the course. HYPOTHESES Medical students in a required course on humanism and values in medicine will have different experiences based on whether a particular student might have or not have elected to enroll in the course. Students uninterested in taking a course in humanism and values, but required to enroll, will limit the benefit of the course for those students originally interested in participating. METHOD In 2012, all 1st-year students at a U.S. medical school were required to take the Healer's Art, an elective on professional values and humanism offered at more than 90 other schools in the United States and internationally. Students completed pre/postcourse surveys assessing emotional exhaustion, work engagement, positive emotions, and cynicism. We analyzed differences between those who would have elected to take the course (Elective students) and those who would not have elected to take it (Required students). RESULTS Elective students did not differ from Required students in baseline demographic characteristics, emotional exhaustion, work engagement, or positive emotions. At baseline, Elective students did report feeling safer to talk openly, a greater sense of community, and higher levels of cynicism. Over time, there were no differences in course evaluations or outcomes between Elective and Required students. CONCLUSIONS Required students do not differ greatly from those who would have elected to take Healer's Art, and all students appear to have similar experiences in the course.
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Affiliation(s)
- Michael W Rabow
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| | - Marissa Lapedis
- a Department of Medicine , University of California, San Francisco , San Francisco , California , USA
| | - Anat Feingold
- b Department of Pediatrics , Cooper Medical School at Rowan University , Camden , New Jersey , USA
| | - Mark Thomas
- c Department of Medicine , Cooper Medical School at Rowan University , Camden , New Jersey , USA
| | - Rachel N Remen
- d Department of Family and Community Medicine , University of California, San Francisco , San Francisco , California , USA
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25
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Puddey IB, Mercer A, Playford DE, Riley GJ. Medical student selection criteria and socio-demographic factors as predictors of ultimately working rurally after graduation. BMC MEDICAL EDUCATION 2015; 15:74. [PMID: 25890081 PMCID: PMC4407300 DOI: 10.1186/s12909-015-0359-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/30/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND We have previously demonstrated that both coming from a rural background and spending a year-long clinical rotation in our Rural Clinical School (RCS) have independent and additive effects to increase the likelihood of medical students practicing rurally following graduation. The current study assesses the extent to which medical school selection criteria and/or the socio-demographic profile of medical students may further facilitate or hamper the selection of students ultimately destined for the rural medical workforce. METHODS The study comprised 729 students, admitted from secondary school since 1999 and having graduated by 2011, whose actual workplace location in 2014 was classified as either urban or rural using the Australian Health Practitioner Regulation Agency database. Selection factors on entry (score from a standardised interview, percentile scores for the 3 components of the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance as assessed by the Australian Tertiary Admissions Rank) together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD)), were examined in relation to ultimate rural destination of practice. RESULTS In logistic regression, those practicing in a rural location in 2014 were more likely to have come from the lower 6 IRSAD deciles (OR 2.75, 95% CI 1.44, 5.23, P = 0.002), to be older (OR 1.86, 95% CI 1.09, 3.18, p = 0.023) and to have a lower UMAT-3 (Non-verbal communication) score (OR 0.98, 95% CI 0.97, 0.99, P = 0.005). After further controlling for either rural background or RCS participation, only age and UMAT-3 remained as independent predictors of current rural practice. CONCLUSIONS In terms of the socio-demographic profiles of those selected for medical school entry from secondary school, only older age weakly augmented the selection of graduates likely to ultimately work in a rural destination. Among the selection factors, having achieved higher scores in UMAT-3 tended to mitigate this outcome. The major focus in attempts to grow the rural medical workforce should therefore remain on recruiting medical students from a rural background together with providing maximal opportunity for prolonged immersion in rural clinical environments during their training.
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Affiliation(s)
- Ian B Puddey
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Annette Mercer
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Denese E Playford
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Geoffrey J Riley
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
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