Graduate entry and undergraduate medical students' study approaches, stress levels and ways of coping: a five year longitudinal study

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

Development and Validation of a Coping Strategies Scale for Use in Chinese Contexts

Individuals’ coping strategies have a profound effect on how well they respond to negative life events. Despite this, most coping strategies instruments that are available currently have been developed exclusively in Western contexts. In the present study, a Coping Strategies Scale (CSS) for use with Chinese participants was developed and validated based on responses from 734 Chinese university students (334 male, 399 female, 1 other). Results supported a seven-factor structure for the CSS, which included the dimensions of Withdrawal, Positive Adaptation, Problem-solving, Disengagement, Prosocial Focus, Seeking Emotional Support, and Self-regulation. The results supported the validity of the seven-factor CSS in terms of its content, associated response processes, internal structure, and relationships with other variables. Based on these results, the CSS provides a psychometrically sound instrument for assessing the coping strategies used by Chinese adults in confronting potentially adverse psychological events.

Leveraging Machine Learning to Understand How Emotions Influence Equity Related Education: Quasi-Experimental Study

BACKGROUND

Teaching and learning about topics such as bias are challenging due to the emotional nature of bias-related discourse. However, emotions can be challenging to study in health professions education for numerous reasons. With the emergence of machine learning and natural language processing, sentiment analysis (SA) has the potential to bridge the gap.

OBJECTIVE

To improve our understanding of the role of emotions in bias-related discourse, we developed and conducted a SA of bias-related discourse among health professionals.

METHODS

We conducted a 2-stage quasi-experimental study. First, we developed a SA (algorithm) within an existing archive of interviews with health professionals about bias. SA refers to a mechanism of analysis that evaluates the sentiment of textual data by assigning scores to textual components and calculating and assigning a sentiment value to the text. Next, we applied our SA algorithm to an archive of social media discourse on Twitter that contained equity-related hashtags to compare sentiment among health professionals and the general population.

RESULTS

When tested on the initial archive, our SA algorithm was highly accurate compared to human scoring of sentiment. An analysis of bias-related social media discourse demonstrated that health professional tweets (n=555) were less neutral than the general population (n=6680) when discussing social issues on professionally associated accounts (χ² [2, n=555)]=35.455; P<.001), suggesting that health professionals attach more sentiment to their posts on Twitter than seen in the general population.

CONCLUSIONS

The finding that health professionals are more likely to show and convey emotions regarding equity-related issues on social media has implications for teaching and learning about sensitive topics related to health professions education. Such emotions must therefore be considered in the design, delivery, and evaluation of equity and bias-related education.

Mindfulness practice correlates with reduced exam-induced stress and improved exam performance in preclinical medical students with the "acting with awareness", "non-judging" and "non-reacting" facets of mindfulness particularly associated with improved exam performance

Background

Medical students demonstrate higher levels of psychological distress compared with the general population and other student groups, especially at exam times. Mindfulness interventions show promise in stress reduction for this group, and in the reduction of cortisol, an established clinical marker of the body’s stress response. This study investigated the relationship of mindfulness to exam-induced stress, salivary cortisol and exam performance in undergraduate medical students.

Methods

A controlled pre-post analysis design with within-groups comparisons. 67 medical students completed the five facet mindfulness questionnaire (FFMQ) and provided saliva samples, from which cortisol was extracted, during group work (control/baseline) and immediately prior to end of year 2 examinations (experimental). Academic performance data was extracted for comparison with measures.

Results

Exam-induced salivary cortisol concentration showed a significant negative relation with exam performance. Total FFMQ score showed a significant positive relation with exam performance and a significant negative relation with exam-induced salivary cortisol. The specific mindfulness facets of acting with awareness, non-judging and non-reacting also showed a positive correlation with exam performance.

Conclusions

This study suggests that there exists an important relationship between mindfulness and the physiological biomarker of stress, cortisol, and this manifests into improved assessment outcomes potentially through healthier, more adaptive coping and stress management strategies. In particular, this study identifies the acting with awareness, non-judging and non-reacting facets of mindfulness to be significantly associated with exam performance suggesting that these may be important facets for clinical educators to target when helping students with mindfulness practice.

Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy

INTRODUCTION

Physician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students' interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients.

METHODS AND ANALYSIS

This project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1-6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills.

ETHICS AND DISSEMINATION

The project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.

Trajectories of learning approaches during a full medical curriculum: impact on clinical learning outcomes

BACKGROUND

No consensus exists on whether medical students develop towards more deep (DA) or surface learning approaches (SA) during medical training and how this impacts learning outcomes. We investigated whether subgroups with different trajectories of learning approaches in a medical students' population show different long-term learning outcomes.

METHODS

Person-oriented growth curve analyses on a prospective cohort of 269 medical students (M_age=21years, 59 % females) traced subgroups according to their longitudinal DA/SA profile across academic years 1, 2, 3 and 5. Post-hoc analyses tested differences in academic performance between subgroups throughout the 6-year curriculum until the national high-stakes licensing exam certifying the undergraduate medical training.

RESULTS

Two longitudinal trajectories emerged: surface-oriented (n = 157; 58 %), with higher and increasing levels of SA and lower and decreasing levels of DA; and deep-oriented (n = 112; 42 %), with lower and stable levels of SA and higher but slightly decreasing levels of DA. Post hoc analyses showed that from the beginning of clinical training, deep-oriented students diverged towards better learning outcomes in comparison with surface-oriented students.

CONCLUSIONS

Medical students follow different trajectories of learning approaches during a 6-year medical curriculum. Deep-oriented students are likely to achieve better clinical learning outcomes than surface-oriented students.

Orientations to Wellbeing in the Context of Medicine and Nursing-A Preliminary Study on Students' Perspective in Their Early University Years

Medicine in the 21^st century needs to be patient-or, rather, person-centered. Accordingly, medical education needs to adopt an authentic student-centered stance and also include an emphasis on wellbeing and quality of life-starting in medical students` university years. Studies on eudaimonic and hedonic aspects of wellbeing in academic contexts might offer valuable insights for conceptualizing and implementing medical teaching. Our research aimed at exploring eudaimonic and hedonic orientations in students in their first years of medical and nursing studies, in relation to outcomes like satisfaction, subjective meaning experience and engagement with university studies. We also wanted to evaluate the feasibility of using a translated version of HEMA (Hedonic and Eudaimonc Motives for Action) Scale in our university students. 120 1<sup>st</sup> and 2<sup>nd</sup> year students of our university completed HEMA and questionnaires evaluating the above-mentioned outcomes, in one session. The instrument demonstrated good reliability (assessed by Cronbach`s alpha coefficients) and also captured valuable correlations with students satisfaction, subjective sense of meaning and engagement with their studies. Importantly, eudaimonic subscores were moderately but significantly correlated with Hedonic enjoyment ones, as previously reported. Exploratory Principal Component Analysis suggested two or three factors, but a larger group would be needed to confirm the factor structure of the Romanian version of the test. Conclusions: HEMA is applicable in this academic context, in Romanian, has good reliability and promises to offer valuable insights into students` orientations, helping us support their aspirations and shape our teaching so that they could benefit the most from it.

International medical students' adaptation to university life in Turkey

OBJECTIVES

The aim of this study is to determine the adaptation process of international medical school students to university life in Turkey.

METHODS

The mixed method design study, including all the international students (n=127) studying at Ege University School of Medicine, is employed. Qualitative data were collected from 23 students selected by purposive sampling technique. Two instruments were utilized for collecting data: Student Adaptation to College Questionnaire (SACQ) and Brief COPE. Focus group interviews were performed for qualitative data collection.

RESULTS

The mean SACQ score of the medical students was found to be 407.44 (SD=68.29). The Academic Adjustment category included the themes of educational goals, different studying habits, accommodation, academic advisor, and scholarship. The Social Adjustment category included the themes of social interaction and support, differences, longing for family, discrimination and its effects on social life. The Personal/Emotional adjustment category included themes of psychological and physiological health problems. The Goal Commitment/Institutional Attachment category included themes of academic and social adaptation as well as the student' communication with education management.

CONCLUSIONS

This study identifies to light critical issues in supporting international students with adaptation problems to university life in Turkey. It is clear that revising the content of education programs to enable international exchange is not sufficient enough by itself to meet the needs of international students.

Interprofessional education in geriatric medicine: towards best practice. A controlled before-after study of medical and nursing students

OBJECTIVES

To investigate nursing and medical students' readiness for interprofessional learning before and after implementing geriatric interprofessional education (IPE), based on problem-based learning (PBL) case scenarios. To define the optimal number of geriatric IPE sessions, the size and the ratio of participants from each profession in the learner groups, the outcomes related to the Kirkpatrick four-level typology of learning evaluation, students' concerns about joint learning and impact of geriatric IPE on these concerns. The study looked at the perception of roles and expertise of the 'other' profession in interprofessional teams, and students' choice of topics for future sessions. Students' expectations, experience, learning points and the influence on the understanding of IP collaboration, as well as their readiness to participate in such education again were investigated.

DESIGN

A controlled before-after study (2014/2015, 2015/2016) with data collected immediately before and after the intervention period. Study includes additional comparison of the results from the intervention with a control group of students. Outcomes were determined with a validated 'Readiness for Interprofessional Learning' questionnaire, to which we added questions with free comments, combining quantitative and qualitative research methods. The teaching sessions were facilitated by experienced practitioners/educators, so each group had both, a clinician (either geratology consultant or registrar) and a senior nurse.

PARTICIPANTS

300 medical, 150 nursing students.

SETTING

Tertiary care university teaching hospital.

RESULTS

Analysis of the returned forms in the intervention group had shown that nursing students scored higher on teamwork and collaboration post-IPE (M=40.78, SD=4.05) than pre-IPE (M=34.59, SD=10.36)-statistically significant. On negative professional identity, they scored lower post-IPE (M=7.21, SD=4.2) than pre-IPE (M=8.46, SD=4.1)-statistically significant. The higher score on positive professional identity post-IPE (M=16.43, SD=2.76) than pre-IPE (M=14.32, SD=4.59) was also statistically significant. Likewise, the lower score on roles and responsibilities post-IPE (M=5.41, SD=1.63) than pre-IPE (M=6.84, SD=2.75).Medical students scored higher on teamwork and collaboration post-IPE (M=36.66, SD=5.1) than pre-IPE (M=32.68, SD=7.4)-statistically significant. Higher positive professional identity post-IPE (M=14.3, SD=3.2) than pre-IPE (M=13.1, SD=4.31)-statistically significant. The lower negative professional identity post-IPE (M=7.6, SD=3.17) than pre-IPE (M=8.36, SD=2.91) was not statistically significant. Nor was the post-IPE difference over roles and responsibilities (M=7.4, SD=1.85), pre-IPE (M=7.85, SD=2.1).In the control group, medical students scored higher for teamwork and collaboration post-IPE (M=36.07, SD=3.8) than pre-IPE (M=33.95, SD=3.37)-statistically significant, same for positive professional identity post-IPE (M=13.74, SD=2.64), pre-IPE (M=12.8, SD=2.29), while negative professional identity post-IPE (M=8.48, SD=2.52), pre-IPE (M=9, SD=2.07), and roles and responsibilities post-IPE (M=7.89, SD=1.69), pre-IPE (M=7.91, SD=1.51) shown no statistically significant differences. Student concerns, enhanced understanding of collaboration and readiness for future joint work were addressed, but not understanding of roles.

CONCLUSIONS

Educators with nursing and medical backgrounds delivered geriatric IPE through case-based PBL. The optimal learner group size was determined. The equal numbers of participants from each profession for successful IPE are not necessary. The IPE delivered by clinicians and senior nurses had an overall positive impact on all participants, but more markedly on nursing students. Surprisingly, it had the same impact on medical students regardless if it was delivered to the mixed groups with nursing students, or to medical students alone. Teaching successfully addressed students' concerns about joint learning and communication and ethics were most commonly suggested topics for the future.

Prevalence of stress and its determinants among residents enrolled in China Standardized Training Program for Resident Doctor (C-STRD) program: A cross-sectional study

BACKGROUND

It has been widely understood that well-trained doctors are crucial for a high-quality public health system and safe patient care. Thus, in 2011, China initiated its first national residency training program, called the China Standardized Training for Resident Doctor (C-STRD), for medical graduates to prepare qualified doctors for the medical care system with increasing demands. So far, no studies have specifically address the prevalence of stress and its determinants among residents enrolled in the C-STRD.

PARTICIPANTS AND METHODS

The research is performed in two stages. In stage I, the authors conducted a pilot study and met 112 C-STRD residents in person. Based on the preliminary data, a revised questionnaire was adopted in stage II, during which the authors conducted a multi-institutional, cross-sectional survey of 340 participants from 11 hospitals in Shanghai in a self-administered manner.

RESULTS

The results showed that C-STRD residents were overall under severe stress as their mean PSS score was 27.5 ± 4.9, which was higher than the threshold of high stress (PSS = 20). Specifically, the PSS score for the residents with Bachelor (MB), Master (MM) and Doctoral of Medicine (MD) educational degree were 26.6 ± 4.1, 27.8 ± 3.5 and 27.1 ± 5.2, respectively (P>0.05). Their stress was mainly associated with their financial income status and workload, as these two factors caused more severe burden than other listed stressors (P<0.05). Specially, the residents indicated that their montly payroll amout were as low as $590.2 ± 127 while no benefit package and allowance were given. Surprisingly, wage arrears up to 5.3 month were reported by 36 (10%) participants. Workload survey showed the residents has high work intensity and inadequate rest. Since no stress management program was provided, the majority of residents tended to cope their stress with unhealthy strategies, such as mesmerizing in TV/computer (88.2%) and overeating (59.7%).

CONCLUSION

The C-STRD residents are at high risk of perceived stress. Although there was a difference in perception of stress for workload and career future among different educational degree owners, low financial income is the major stressor among all C-STRD residents. Unhealthy stress management strategies were adopted by all residents due to lack of appropriate stress-relieving intervention.

Distribution and academic significance of learning approaches among pre-clinical medical students at Trinity School of Medicine, St Vincent and the Grenadines

PURPOSE

Different students may adopt different learning approaches: namely, deep and surface. This study aimed to characterize the learning strategies of medical students at Trinity School of Medicine and to explore potential correlations between deep learning approach and the students' academic scores.

METHODS

The study was a questionnaire-based, cross-sectional, observational study. A total of 169 medical students in the basic science years of training were included in the study after giving informed consent. The Biggs's Revised Two-Factor Study Process Questionnaire in paper form was distributed to subjects from January to November 2017. For statistical analyses, the Student t-test, 1-way analysis of variance followed by the post-hoc t-test, and the Pearson correlation test were used. The Cronbach alpha was used to test the internal consistency of the questionnaire.

RESULTS

Of the 169 subjects, 132 (response rate, 78.1%) completely filled out the questionnaires. The Cronbach alpha value for the items on the questionnaire was 0.8. The score for the deep learning approach was 29.4± 4.6, whereas the score for the surface approach was 24.3± 4.2, which was a significant difference (P< 0.05). A positive correlation was found between the deep learning approach and students' academic performance (r= 0.197, P< 0.05, df= 130).

CONCLUSION

Medical students in the basic science years at Trinity School of Medicine adopted the deep learning approach more than the surface approach. Likewise, students who were more inclined towards the deep learning approach scored significantly higher on academic tests.

Self- Perceived Stress in Relation to Anxiety, Depression and Health-related Quality of Life among Health Professions Students: A Cross-sectional Study from Bosnia and Herzegovina

INTRODUCTION

The purpose of the present study was to examine self-perceived stress of health professions students at the Faculty of Medicine Foča, and to explore its association with anxiety, depression and health-related quality of life.

METHODS

The cross-sectional study enrolled 451 students at the Faculty of Medicine (medicine, dentistry, nursing and speech therapy). Survey instruments were distributed at the conclusion of the spring semester during the last required lecture for each year and study programme class. Perceived stress was assessed using the 14-item Perceived Stress Scale. The students were evaluated for symptoms of depression and anxiety, using Zung's self-assessment inventory for depression and the Spielberger State-Trait Anxiety Inventory (STAI). European Quality of Life-5 dimensions were used for describing and evaluating health. Multivariate analyses were carried out using logistic regression to examine the relationship between the outcome variable and selected determinant factors.

RESULTS

A high degree of stress was reported by 1.6% of students, while the majority of students had either moderate (70.6%) or low degree (27.5%) of stress. The significant independent factors associated with perceived stress were anxiety score (OR, 0.339; CI 95%, 0.276-0.403) and EQ-5D score (OR, 0.044; CI 95%, 0.033-0.085). A high degree of perceived stress (OR, 0.624; CI 95%, 0.507-0.704), the presence of depression (OR, 0.800; CI 95%, 0.513-1.087), and low quality of life were associated with anxiety (OR, 0.073; CI 95%, 0.018-0.128).

CONCLUSION

Higher levels of perceived stress predispose health professions students for anxiety and lower quality of life. The study programme was not a significant determinant of perceived stress sore.

The transition to self-regulated learning for first-year dental students: threshold concepts

Research shows that when students arrive at university they are often not prepared for independent learning. New students enter a period of transition during their first year, which is often characterised by emotional destabilisation, as they move towards becoming more self-regulating in their new learning environment. In this small-scale qualitative study, data from an in-depth pair interview were triangulated with data from a questionnaire, to explore participants' experiences of self-regulated learning in the first year of a Dental Surgery course. Five threshold concepts relating to learning in transition emerged from the analysis of the data. These concepts were as follows: learning how to learn using a range of self-chosen sources instead of a single textbook, learning how to organise incoming information without guidance, distinguishing between main ideas and detail during revision, coping with a heavy workload, and knowing what to expect from examinations and coursework. Strong emotions (feeling confused, overwhelmed and scared) were associated with negotiating these threshold concepts. However, the study illustrates how the participants adopted new cognitive and metacognitive strategies to become more self-regulating over time. The findings of the study suggest that lecturers, tutors, study advisers and peers all have an important role to play in explicitly guiding first-year students as they grapple with troublesome threshold concepts relating to self-regulated learning. Furthermore, structural changes to the content-heavy, lecture-based curricula often associated with first-year Medical and Dental courses would help ease students' transition to independent learning, which may make an impact on student attainment.

Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators

INTRODUCTION

Against a backdrop of ever-changing diagnostic and treatment modalities, stakeholder perceptions (medical students, clinicians, anatomy educators) are crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. This study compared perceptions of students, practising clinicians, and anatomy educators with respect to the relevance of anatomy education to medicine.

METHODS

A quantitative survey was administered to undergraduate entry (n = 352) and graduate entry students (n = 219) at two Irish medical schools, recently graduated Irish clinicians (n = 146), and anatomy educators based in Irish and British medical schools (n = 30). Areas addressed included the association of anatomy with medical education and clinical practice, mode of instruction, and curriculum duration.

RESULTS

Graduate-entry students were less likely to associate anatomy with the development of professionalism, teamwork skills, or improved awareness of ethics in medicine. Clinicians highlighted the challenge of tailoring anatomy education to increase student readiness to function effectively in a clinical role. Anatomy educators indicated dissatisfaction with the time available for anatomy within medical curricula, and were equivocal about whether curriculum content should be responsive to societal feedback.

CONCLUSIONS

The group differences identified in the current study highlight areas and requirements which medical education curriculum developers should be sensitive to when designing anatomy courses.