Motives, experiences and psychological strain in medical students engaged in refugee care in a reception center- a mixed-methods approach

Storylines of Trauma in Health Professions Education: A Critical Metanarrative Review

PHENOMENON

Learners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof.

APPROACH

A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives.

FINDINGS

Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues.

INSIGHTS

Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma.

"I Didn't Expect to Be So Caught Up in It": a Qualitative Study of Experiences of Medical Students' Volunteering for Ukrainian Refugees

OBJECTIVE

Russia's invasion of Ukraine in February 2022 triggered a huge wave of migration, with thousands of refugees arriving at Prague's Central Station. With no medical service available, medical students started to volunteer and were running an infirmary available around the clock. The research aimed to explore medical students' professional experiences, emotionally challenging situations, and coping strategies in this demanding setting.

METHODS

The authors used a qualitative analysis of semi-structured in-depth interviews with 19 participants recruited through purposive sampling. Interviews took place between April and May 2022. Data were recorded, transcribed, and processed by using thematic qualitative analysis.

RESULTS

The research identified five emotionally challenging situations: caring for traumatized refugees, refusal of treatment, disruption of everyday life, independent decision-making, and complexity of voluntary work. Students adopted both adaptive and maladaptive coping strategies for dealing with stress and trauma. Almost half the students reported signs of secondary traumatization and moral distress; however, no one asked for psychological help.

CONCLUSIONS

Medical school curricula should cover trauma-informed approaches, healthy coping strategies, and destigmatization of psychological problems.

In the face of horror - secondary traumatisation and mental distress in employees and volunteers at national socialism related memorial sites

Background: Employees and volunteers at national socialism related memorial sites in Germany (MemoS) are confronted with severely aversive documents of German history on a regular basis.Objective: Enhance knowledge on mental health in MemoS.Method: In an online study, mental distress, secondary traumatisation as well as potential risk and protective factors were assessed in MemoS and a control group.Results: 40.9% of MemoS reported at least one kind of secondary traumatic event experienced in the context of their work. Depression and general mental distress were higher in the MemoS than in controls, and symptoms of secondary traumatisation were significantly more common.Conclusions: Our results give clear evidence for mental distress and symptoms of secondary traumatisation in the MemoS group. This finding shows secondary traumatisation symptoms based on documents of atrocities that happened more than 70 years ago. Further, the high mental burden in the MemoS suggests the necessity of supervision for people dedicating their work life to assuring remembrance of the crimes of the Nazi era.

Volunteering in the front line of the Ukrainian refugee crisis: A brief report from Poland

This study aims to analyse the experiences and motivations of volunteers who supported Ukrainian refugees who fled to Poland. Our study was conducted among 196 volunteers in Poznan, Poland who answered questions regarding their experiences with voluntary service during the current refugee crisis and the reasons they became involved in volunteer efforts. We found that although the Polish state had no prior experience in welcoming refugees on a mass scale, the Russo-Ukrainian War has resulted in the emergence of “spontaneous volunteers” who have offered their help and assistance to the flood of refugees sweeping in from its eastern neighbor. We also found that because many Polish citizens believe that helping those in need should not rest solely on the government there are two main motivations to volunteer: a general willingness to help and the willingness to volunteer on behalf of Ukrainian refugees. Finally, while this study highlights that in times of crisis, most people are primarily motivated by humanistic and democratic values, including altruism and public service, emotions also play an important role in influencing people's decision to engage in voluntary service.

Volunteering in the front line of the Ukrainian refugee crisis: A brief report from Poland

This study aims to analyse the experiences and motivations of volunteers who supported Ukrainian refugees who fled to Poland. Our study was conducted among 196 volunteers in Poznan, Poland who answered questions regarding their experiences with voluntary service during the current refugee crisis and the reasons they became involved in volunteer efforts. We found that although the Polish state had no prior experience in welcoming refugees on a mass scale, the Russo-Ukrainian War has resulted in the emergence of "spontaneous volunteers" who have offered their help and assistance to the flood of refugees sweeping in from its eastern neighbor. We also found that because many Polish citizens believe that helping those in need should not rest solely on the government there are two main motivations to volunteer: a general willingness to help and the willingness to volunteer on behalf of Ukrainian refugees. Finally, while this study highlights that in times of crisis, most people are primarily motivated by humanistic and democratic values, including altruism and public service, emotions also play an important role in influencing people's decision to engage in voluntary service.

The role of volunteering in supporting well-being - What might this mean for social prescribing? A best-fit framework synthesis of qualitative research

Volunteering for an organisation, charity or group enables people to make connections with others and to be involved in interesting, worthwhile and/or enjoyable pursuits. Engaging in volunteering can form part of a social prescribing action plan developed between a patient and link worker. Greater understanding of the processes through which volunteering can improve people's well-being as part of social prescribing will help to support link workers in their role. We conducted a best-fit framework synthesis of qualitative literature on volunteering and well-being. Our search of eight electronic databases, complemented by a Google search, conducted in June 2020, resulted in the location of 2210 potentially relevant references. After screening, 335 papers were read in full and 54 drawn upon within the review. They were published between 1993 and 2020. We used the New Economics Foundation's Five Ways to Well-Being model to guide data extraction and synthesis. From this, we developed a conceptual framework that highlights how volunteering can contribute to identity validation and modification leading to the establishment of an acceptable sense of self. Our findings have implications for: (a) the use of volunteering as part of a link worker's toolkit as they seek to support people with varying psychosocial needs and (b) requirements of organisations accepting referrals to volunteering as part of social prescribing.

Medical students' mental burden and experiences of voluntary work in COVID-19 patient support and treatment services: a qualitative analysis

Aim: Medical training is undergoing a dramatic shift toward alternative training methods due to the SARS-CoV-2 pandemic. This study is the first to examine medical students' expectations, experiences, and mental burden related to volunteering in COVID-19 patient support and treatment services using semi-structured interviews. Methods: In May 2020, all 194 Heidelberg University Medical School students involved in volunteer COVID-19 support and treatment services were invited to participate in a cross-sectional, qualitative interview study. The semi-structured interviews were digitally recorded, transcribed, and then analyzed using Mayring's principles for content analysis. Results: We interviewed 12 medical students (8 female, mean age 23.2 years, mean medical training 3.7 years) working in Heidelberg COVID-19 crises management services, i.e., the Heidelberg Medical Hospital COVID-19 inpatient and outpatient units. The analysis revealed two key themes: "Expectations and structural barriers" and "Experiences and mental burden". The participants reported uncertainty and apprehension before starting their voluntary work. Although they initially found volunteering to be somewhat disorganized, their roles became clearer with time. In addition, they reported good team cohesion, which helped reduce initial concerns and uncertainties. The participants also felt that working in the field had helped them maintain their professional identification while standard medical classes and bedside learning were suspended due to the COVID-19 crises. Overall, they reported little volunteer work-related mental burden. Conclusions: The participants felt that volunteering during the COVID-19 crisis had benefited their professional development. A designated liaison person, psychosocial support, and introductory and accompanying courses could help alleviate initial concerns and interim difficulties in future crisis-related assignments.

A Qualitative Evaluation of a Mother and Child Center Providing Psychosocial Support to Newly Arrived Female Refugees in a Registration and Reception Center in Germany

Female refugees are frequently exposed to sexualized, gender-based violence and harassment before, during, and after their flight. Yet female refugee-specific care and protection needs are rarely addressed in host countries. This study aimed to evaluate a mother and child center (MUKI) for female refugees in a reception and registration center in Germany. In 2017, we conducted semi-structured qualitative interviews with 16 female refugees attending the MUKI and with its five main staff members. We asked the participants about the MUKI’s relevance, encountered difficulties, and suggestions for improvement. The interviewees appreciated the MUKI’s sheltered environment, care services, and socializing opportunities, as well as its women-only concept. Overall, the participants saw overexertion, social engagement-related difficulties, and the MUKI’s noisy environment as key attendance barriers. Interviewed staff primarily reported problems regarding the working conditions, including the high staff and attendee turnover and low general service awareness. The participants advocated an expansion of the MUKI program. The MUKI project underlines that providing newly arrived, vulnerable female refugees with sheltered surroundings and psychosocial services is an essential step toward addressing female refugees’ specific care needs.

Prevalence and risk factors of secondary traumatic stress in emergency call-takers and dispatchers - a cross-sectional study

Background: Emergency call-takers and dispatchers (ECDs) field emergency calls and dispatch the appropriate emergency services. Exposure to the callers' traumatic experiences can lead to psychological stress and even to secondary traumatic stress (STS). In addition, previous studies suggest that ECDs may also suffer from posttraumatic stress disorder (PTSD), depression and anxiety disorders. Objectives: To investigate the prevalence of STS and to screen for PTSD, depression and anxiety disorders in ECDs. We further aimed to identify sociodemographic variables and attachment styles as possible risk factors for higher STS symptom load in ECDs. Methods: STS and PTSD regarding lifetime traumatic events, as well as depression and anxiety disorders, were investigated in N = 71 ECDs. Multiple regression analysis was performed to identify possible risk factors for higher STS symptom load. Results: The analysis determined a prevalence of 8.5% for moderate STS and 2.8% for severe STS. A total of 11.3% of the ECDs screened positive for PTSD, 15.5% for depression and 7.0% for anxiety disorders. A higher number of children and the absence of a secure attachment style were identified to be significantly associated with higher STS symptom load. Conclusions: STS resulting from exposure to traumatic emergency caller content is a common phenomenon among ECDs. Specific sociodemographic variables and the attachment style are significant risk factors of STS symptom load. ECDs should receive regular psychoeducational interventions and supervision to identify and mitigate mental distress at an early stage.

Consternation and complexity: learning from people who seek asylum

People seeking asylum experience health inequalities, and it is challenging to meet their needs in primary care. Consultations can feel overwhelming; however, there are excellent opportunities for Transformational Learning, transferable to other vulnerable people. A critical approach to evidence-based medicine, emphasising values, can be used to mitigate the consternation generated by these encounters and expand learners' perceptions about their roles and responsibilities. Global health, diversity, discrimination, intersectionality and power differentials can be explored. Realisation of the part practitioners play in leadership and advocacy is key. Helping the most marginalised is crucial to understanding patient-safety and quality improvement. Community-orientated approaches are performed well by Voluntary and Community Organisations. There is much to learn about co-production and their 'No Wrong Door' philosophy. Recognition of health literacy and promoting cultural sensibility for a growing population with Limited English Proficiency, also requires learning advanced communication skills. Developing therapeutic trust with forced migrants subjected to ill-treatment brings skills and behaviour relevant to other challenging encounters in primary care. Vicarious traumatisation is well-recognised when dealing with the sequelae of violence and, aided by their educators, primary care learners must understand ways to protect themselves and reflect on vicarious resilience, through recognising meaning in their work.