Influence of clerks' personality on their burnout in the clinical workplace: a longitudinal observation

Effects of grit on medical students' wellbeing during clerkships: a longitudinal observational cohort study

Introduction

In medical education, the clerkship phase is a demanding period during which medical students learn to navigate the responsibilities of medical school and clinical medicine. Grit, a personal quality regarded as a non-cognitive trait, refers to perseverance and passion; specifically, it represents the ability to endure hardship and work industriously toward a goal. Most studies analysed grit as a single concept and few studies have investigated the effect of grit on the well-being of medical students through the whole-specialty training (i.e. surgical and non-surgical specialty rotations) required in clinical clerkships. Therefore, this study investigated whether associations exist between medical students' grit, measured by the two subconstructs of perseverance and passion, and their well-being during clerkships in surgical and non-surgical specialty units.

Methods

This one-year prospective web-based questionnaire study enrolled fifth-year medical students at a tertiary medical centre in central Taiwan between September 2017 and July 2018 in their first-year clerkship. The students' sex, age, and grit were measured at the start of their clerkship. Routine surveys were conducted over one year to assess burnout and compassion satisfaction for students' well-being, and the training specialty characteristics of the surgical and non-surgical specialty departments were recorded. This study included 92 medical students and 1,055 survey responses from individual specialty rotations. Descriptive, univariate and multivariate analyses were performed.

Results

Our results revealed that medical students' perseverance, as part of grit, was related to lower burnout and higher compassion satisfaction during clerkships, but not the subconstruct of passion. Moreover, the positive trait of perseverance measured in our study had greater explanatory power for compassion satisfaction than for burnout. Furthermore, the results revealed that older medical students suffered from less burnout than their younger counterparts, and that male medical students expressed higher compassion satisfaction than their female counterparts.

Discussion

Perseverance, as a subconstruct of grit, is a positive personal quality for medical students' clerkships, and methods driving the cultivation of perseverance in medical education should be considered. In addition, even though positive traits such as perseverance equipped medical students for compassion satisfaction, additional factors attributed to medical students' burnout must be identified.

The mediating role of psychological flexibility in the association of autistic-like traits with burnout and depression in medical students during clinical clerkships in Japan: a university-based cross-sectional study

BACKGROUND

Burnout and depression among medical students is linked to serious problems that require appropriate solutions. Subthreshold autism traits or autistic-like traits (ALTs) may be possible factors associated with burnout and depression. The effectiveness of acceptance and commitment therapy (ACT) for burnout and depression has been widely reported. The treatment aims to improve psychological flexibility, a concept indicating engagement in personal value-based behaviors without avoiding uncomfortable private experiences. This study examined whether ALTs were associated with burnout or depression among medical students during clinical clerkships in Japan, and then investigated what psychological flexibility processes might mediate these associations.

METHODS

A cross-sectional survey was administered to 284 medical students at Nagoya City University School of Medical Sciences who had been in clinical clerkships for 10 months or longer. Linear multiple regressions were performed with each burnout factor or depression as the outcome variable using validated tools measuring burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), ALT (Autism-Spectrum Quotient Japanese version-21), and psychological flexibility processes (Cognitive Fusion Questionnaire-7 and Valuing Questionnaire). Additionally, a mediation analysis was conducted using structural equation modeling.

RESULTS

A linear multiple regression analysis that controlled for age and gender found that ALTs were significantly associated with lower personal accomplishment, a factor of burnout, and depression. Lower personal accomplishment was also associated with males and lower progress toward values of the psychological flexibility process. Depression was also associated with males and higher cognitive fusion, lower progress towards values, and higher obstruction to values of the psychological flexibility process. Surprisingly, emotional exhaustion and depersonalization were not significantly associated with ALTs. The mediation analysis revealed that the relationship between ALTs and personal accomplishment was partially mediated by a process of progress toward values, while the relationship between ALTs and depression was partially mediated by both processes of progress toward values and cognitive fusion.

CONCLUSIONS

ALTs were significantly associated with lower personal accomplishment of burnout and depression among medical students in clinical clerkships. Consideration should be given to the psychological flexibility processes that focus on interventions targeting psychological flexibility for medical students with ALTs to reduce burnout and depression.

Effect of national curriculum reform on medical students' preparedness for practice: a prospective cohort study from undergraduate to postgraduate periods

BACKGROUND

In recent years, a national curriculum reform was implemented in undergraduate medical education in Taiwan to reduce clinical rotation training from 3 years to 2 years. The last generation of the old curriculum and the first generation of the new curriculum both graduated in 2019. This study aimed to compare the learning outcomes of the medical students in these two curriculum groups in terms of preparedness for practice during the transition from undergraduate to postgraduate study.

METHODS

This was a 3-year prospective, longitudinal, comparative cohort study between 2017 and 2020. Medical students from both the 7-year and 6-year curriculum groups received biannual questionnaire surveys starting 18 months before graduation and running until 11 months after graduation. The measurement tools were the Preparedness for Hospital Practice Questionnaire (PHPQ) and Copenhagen Burnout Inventory (CBI). Personal demographic information was also collected. Linear mixed models were used to determine the effect of curriculum change on learners' preparedness and burnout levels.

RESULTS

A total of 130 medical students from the two cohorts provided 563 measurements during the study period. Compared to their counterparts following the old curriculum, the participants following the new curriculum showed a lower level of preparedness when first entering clinical rotation (p = 0.027) and just after graduating (p = 0.049), especially in the domains of clinical confidence (p = 0.021) and patient management p = 0.015). The multivariate linear mixed model revealed gradual increases in preparedness and burnout in serial measurements in both curriculum groups. Students following the new curriculum, which involved a shortened clinical rotation, showed a slightly lower overall preparedness (p = 0.035) and the same level of burnout (p = 0.692) after adjustment. The factor of year of change did not show a significant effect on either preparedness (p = 0.258) or burnout (p = 0.457).

CONCLUSION

Shortened clinical rotation training for medical undergraduates is associated with a decrease in preparedness for practice during the transition from undergraduate to postgraduate study. Clinical confidence and patient management are the main domains affected.

The importance of personality traits for predicting clinical clerkship grades and USMLE scores

Background: Important aspects of medical school success are thought to rely on non-cognitive attributes such as personality traits. Methods: In a sample of medical students who completed their 3rd-year clerkships, the current study examined the impact of personality traits on performance on four measures of 3rd-year clerkship grades and United States Medical Licensing Examination (USMLE) Step 2CK (Clinical Knowledge) scores. Results: We found that specific personality traits, including conscientiousness, achievement-striving, morality, and self-efficacy predicted multiple outcome measures, including Step 2CK performance. However, while we observed a clear link between personality and success during the 3rd year, we also found that Step 1 scores, not specific or grouped personality traits, best predicted all measures of clerkship performance except clerkship evaluations and, as expected, best predicted Step 2CK performance. Additionally, we created a composite personality profile for our sample by averaging the high and low scores of the Big Five personality trait scales and their subscales. However, this personality composite, which included the traits agreeableness, cooperation, Conscientiousness, and cautiousness, did not predict any of our outcome measures. Conclusions: These findings indicate that personality traits individually and in combination predict 3rd year medical school success, especially when performance may rely less on intellectual prowess, and more on personality factors. Importantly, however, Step 1 scores were usually much better predictors not only of Step 2CK and shelf exam performance, but even overall clerkship grades and Objective Structured Clinical Examination (OSCE) performance. We hope these results can be used to help clerkship directors and faculty understand that personality factors impact medical school performance and that they should be considered when evaluating the more non-cognitive aspects of student achievement.

Medical student wellness in Canada: time for a national curriculum framework

There is substantial evidence showing that medical student wellness is a worsening problem in Canada. It is apparent that medical students' wellness deteriorates throughout their training. Medical schools and their governing bodies are responding by integrating wellness into competency frameworks and accreditation standards through a combination of system- and individual-level approaches. System-level strategies that consider how policies, medical culture, and the "hidden curriculum" impact student wellness, are essential for reducing burnout prevalence and achieving optimal wellness outcomes. Individual-level initiatives such as wellness programming are widespread and more commonly used. These are often didactic, placing the onus on the student without addressing the learning environment. Despite significant progress, there is little programming consistency across schools or training levels. There is no wellness curriculum framework for Canadian undergraduate medical education that aligns with residency competencies. Creating such a framework would help align individual- and system-level initiatives and smooth the transition from medical school to residency. The framework would organize goals within relevant wellness domains, allow for local adaptability, consider basic learner needs, and be learner-informed. Physicians whose wellness has been supported throughout their training will positively contribute to the quality of patient care, work environments, and in sustaining a healthy Canadian population.

Relationship between medical students' negative perceptions of colleagues' work-life and burn-out during clerkships: a longitudinal observational cohort study

OBJECTIVE

Because work and educational environments are closely related and can affect each other, this study examined whether medical students' negative perceptions of their colleagues' work-life balance (NWLB) during their clinical rotations would be related to burn-out in clerkships and investigated the effect of students' gender on this relationship.

DESIGN

A longitudinal, prospective 2-year cohort study conducted between September 2013 and April 2015.

SETTING

Medical students from a university school of medicine in Taiwan.

PARTICIPANTS

One voluntary cohort of undergraduate medical students in clerkships was invited to participate. Among 190 medical students recruited in September 2013, a total of 124 students provided written informed consent. Participants were free to decide whether to complete each survey; therefore, varying numbers of responses were obtained during the study period. Those who responded to our survey for more than 6 months were included in our analyses. Overall, 2128 responses from 94 medical students were analysed, with each student providing an average of 23 responses for 2 years.

PRIMARY OUTCOME MEASURE

Burn-out was measured using the Professional Quality of Life Scale.

RESULTS

Our study found that a strong NWLB was related to high burn-out levels among medical students during their clerkships (p<0.001). However, the gender of the student had no effect on this relationship (p>0.05). In addition, our study indicated that medical students living with a companion had decreased burn-out levels than did those living alone during their clerkships.

CONCLUSIONS

The significance of policies promoting employee work-life balance should be emphasised because of the potential for social contagion effects on medical students. Clerkship trainees might be vulnerable to such negative contagion effects during the transition to their early clinical workplace training and may, therefore, require advanced socialisation and mentoring.

The influence of personality, alexithymia and work engagement on burnout among village doctors in China: a cross-sectional study

BACKGROUND

In China, as the "gatekeepers"of rural residents' health, the primary-level village doctors, play a very crucial role in ensuring and serving the health level of rural residents. However, the burnout of village doctors is gravely threatening the stability of rural primary medical system step by step. This study systematically evaluated the effects of personality, work engagement and alexithymia on burnout of village doctors, and further measured and assessed the mediating effect of alexithymia and work engagement in the association between personality and burnout.

METHODS

The subjects were 2684 village doctors in Jining, Shandong Province, China, from May to June 2019. Sociodemographic characteristics, alexithymia, personality, work engagement and job burnout were quantitated by self-completed questionnaire and measured by Likert 5-7 scale. One-way ANOVA, Person correlation analysis, and Structural Equation Modelling (SEM) were used for statistical analysis and mediating effect evaluation.

RESULTS

2693 questionnaires were collected in total, of which 2684 were valid, with an effective rate of 96.2%. 65.2% of village doctors were diagnosed with burnout, and 54.3% showed moderate to severe emotional exhaustion, 61.6% showed moderate to severe low sense of personal achievement, and 33.9% showed moderate to severe depersonalization burnout. Personality had a direct positive effect on work engagement (β = 0.50, p < 0.001), a direct negative effect on alexithymia (β = - 0.52, p < 0.001) and burnout (β = - 0.50, p < 0.001) respectively. Work engagement had a direct negative effect on burnout (β = - 0.10, p < 0.001), while alexithymia had a direct positive effect on burnout (β = 0.16, p < 0.001). In the path between personality and burnout, both work engagement 95%CI:(- 0.17)-(- 0.08), and alexithymia 95%CI:(- 0.36)-(- 0.09), have significant mediating effects. These results strongly confirm that personality, alexithymia, and work engagement are early and powerful predicators of burnout.

CONCLUSION

According to the results, medical administrators should pay attention to the personality characteristics of village doctors in vocational training, practice selection and job assignment, encourage village doctors to reflect on their own personality actively, and to reduce job burnout by obtaining necessary social support, constructing reasonable achievable career expectations, improving time management ability, and participating in psychological counselling programs.

A comprehensive review of compassion fatigue in pre-licensure health students: antecedents, attributes, and consequences

Compassion fatigue has been documented in the nursing and allied health literature as an emerging issue for health professionals. Little is known regarding the experience of compassion fatigue in undergraduate, pre-licensure students entering health care professions. This study used Walker and Avant's concept analysis methodology to explain antecedents, attributes, and consequences of compassion fatigue in undergraduate, pre-licensure students. Exploration of the published literature from January 1992-April 2020 occurred using systematic review criteria based on the Joanna Briggs Institute. Findings revealed three antecedents that included: Coping Ability; Self-Efficacy; and Clinical and Occupational Hazards. Three defining attributes of compassion fatigue included: Psychological Stress; Witnessing Negative Experiences of Others; and Depression. Consequences included: Decreased Well-Being; and Program Withdrawal and Intention-to-Leave. The results offer new perspectives and opportunities for research in pre-licensure health studies undergraduate students expected to uphold the values of their professional program prior to entry into the workforce.

Determinants and effects of medical students' core self-evaluation tendencies on clinical competence and workplace well-being in clerkship

Core self-evaluation (CSE) is a personality trait that involves a person’s evaluation of his or her own worth, competence, and capability. The objective of this study was to determine whether medical students’ CSEs exert beneficial effects on their adaptation to their clerkship in terms of their clinical competence and workplace well-being and whether their preclinical academic performance can be a trait-relevant situation that enhances their CSE expression. In total, 127 medical students from 2 cohorts were included as participants in this study. We analyzed complete measures of personal background, objective and subjective preclinical academic performance (course evaluation grades and self-reported efficacy), CSE tendencies, and clinical competence (as objective structured clinical examination scores) and workplace well-being (as compassion satisfaction and burnout) during their 2-year clerkship. Mixed linear models for repeated measures and multiple regressions were employed. Participants’ CSE tendencies had positive effects on their workplace compassion satisfaction and burnout but not on their clinical competence during their clerkship. Additionally, using the objective and subjective preclinical academic performance of the medical students as indicators, we observed that neither could be trait-relevant situations to enhance their CSE expression. CSE personality tendencies might be key to medical students’ ability to noncognitively adapt to clinical training during their clerkships. These tendencies should be identified earlier so that mentors can provide prompt care and support to mentees (medical students) during clerkships.

Adoption and correlates of Postgraduate Hospital Educational Environment Measure (PHEEM) in the evaluation of learning environments - A systematic review. MEDICAL TEACHER 2016;38:1248-1255. [PMID: 27564848 DOI: 10.1080/0142159x.2016.1210108]

BACKGROUND

The Postgraduate Hospital Educational Environment Measure (PHEEM) is a highly reliable and valid instrument to measure the educational environment during post graduate medical training. This review extends earlier reports by evaluating the extant adoption of PHEEM in various international clinical training sites, and its significant correlations in order to expand our understanding on the use of PHEEM and facilitate future applications and research.

METHOD

A systematic literature review was conducted on all articles between 2005 and October 2015 that adopted and reported data using the PHEEM.

RESULTS

Overall 30 studies were included, encompassing data from 14 countries internationally. Notable differences in the PHEEM scores were found between different levels of training, disciplines, and clinical training sites. Common strengths and weaknesses in learning environments were observed and there were significant correlations between PHEEM scores and In-Training Exam (ITE) performance (positive correlation) and level of burnout (negative correlation), respectively.

CONCLUSIONS

PHEEM is widely adopted in different learning settings, and is a useful tool to identify the strengths and weaknesses of an educational environment. Future research can examine other correlates of PHEEM and longitudinal changes in interventional studies.

Training demands on clerk burnout: determining whether achievement goal motivation orientations matter

BACKGROUND

In the education field, learning experiences are considered learners' properties and are viewed as a key determinant in explaining learners' learning processes, especially for training novices such as clerks with varying levels of commitment to the medical profession. This study explored whether clerks' achievement goal motivation orientations might buffer the negative well-being to a certain extent, considering their training demands during clinical training.

METHODS

Ninety-four clerks at a tertiary medical center were longitudinally traced during their 2-year clerkship spanning from September 2013 to April 2015. Web-based, validated, structured, self-administered questionnaires were used to evaluate the clerks' properties of achievement goal motivation orientation and personal background at the beginning of the clerkship. Regular surveys were conducted to evaluate their perceptions of training demands and burnout at each specialty rotation. Overall, 2230 responses were analyzed, and linear mixed-effects models were used to examine the repeated measures of the clerks.

RESULTS

The results revealed that higher perceived psychological and physical demands of training were related to higher perceived burnout during the 2-year clerkship. Although both the clerks' task and ego orientations were related to reduced burnout (direct effects), only task orientation was indicated to exert a buffering effect on their perception of physical demands on burnout in the 1st year of the clerkship.

CONCLUSIONS

Considering the negative effects of training demands (psychological and physical), we observed a limited effect of the task achievement motivation orientation of medical students; therefore, additional studies might focus on strategies to facilitate medical students in clerkships in addressing both the psychological and physical demands inherent in training workplaces to improve their learning experience and well-being.