A longitudinal investigation of mental health, perceived learning environment and burdens in a cohort of first-year German medical students' before and during the COVID-19 'new normal'

Uncovering heterogeneity in mental health changes among first-year medical students

INTRODUCTION

The initial year of medical school is linked to a decline in mental health. To assess mental health comprehensively, the dual-factor model posits the consideration of both psychopathology (e.g., depression) and positive mental health (e.g., well-being). Previous mental health research among medical students has primarily examined these two factors independently. This study uses the dual-factor approach for a deeper understanding of mental health changes during the first year of medical school.

METHODS

Students from eight German medical schools (N = 450) were surveyed three times (T0 = entering medical school, T1 = end of the first semester, T2 = end of the second semester) regarding depression (PHQ-9), well-being (subscale of FAHW-12), and general life satisfaction (German Single-Item Scale L1). Latent profile analysis was used to identify distinct mental health groups based on their combinations of psychopathology and positive mental health. We then analysed trajectories descriptively by examining the longitudinal stability and dynamics of mental health group membership during the first year of medical school.

RESULTS

We identified five mental health groups: (1) complete mental health, (2) moderately mentally healthy, (3) symptomatic but content, (4) vulnerable, and (5) troubled. The examination of change trajectories unveiled diverse paths pointing towards both recovery and deterioration. In comparison to the other groups, students belonging to the complete mental health group exhibited greater stability and a higher potential to recover after initial deteriorations in the first semester.

CONCLUSIONS

Our study uncovers distinct mental health trajectories in the first year of medical school, emphasizing the crucial role of initial mental health status. Our findings stress the diverse nature of mental health changes in medical students, underscoring the need for tailored prevention strategies. The implications for research and practice are discussed.

Development and implementation of digital peer mentoring in small groups for first-year medical students

Introduction

Mentoring has become an important educational strategy in medical training. Peer mentoring (PM) can enhance student experience and support transition to higher education. This article documents the implementation of an online peer mentoring program for first year medical students at a newly founded medical school in Germany during the COVID-19 pandemic and its development into in-person PM.

Project description

We developed the program in close collaboration between students and teachers. Students were invited to apply as peer mentors via email; they received instructions and reflected on their role and experiences in meetings before, during and after the semester. One or more peer mentors were assigned randomly to a student group. We evaluated the program with an online survey inspired by the "Modified Mentorship Effectiveness Scale". After successful piloting PM was implemented into the core curriculum.

Results

In 2020 we assigned 17 peer mentors to 14 groups of 6-7 students. Groups met 3 or more times via Zoom®. Overall satisfaction was high. Both student groups reported benefits for their personal and professional identity formation. Atmosphere in online meetings was excellent. Most important topics were exams/learning strategies. In 2021 meetings were held in person. Overall satisfaction, perceived benefits and learning atmosphere were again rated very positively. Most students preferred many-to-many PM and random matching.

Conclusion

The implementation of PM was successful and beneficial for the participating students. PM can help first-year medical students reduce anxiety, improve self-organization and orientation at university. It fosters identity formation and has positive effects on peer mentees as well as on peer mentors.

Academic climate and psychopathological symptomatology in Spanish medical students

INTRODUCTION

Medical Education studies suggest that medical students experience depression, anxiety and psychopathological symptomatology in a proportion higher than in the rest of the population. In the present study, we aimed to conduct a nationwide analysis to describe student's perceptions of Educational Climate in Spanish medical schools, and its relationship with psychopathological symptomatology.

METHODS

The study was carried out in 2022 in all 44 medical schools in Spain, and analyses the academic climate, and psychopathological symptomatology among medical students (n = 4374). To measure these variables, we used the Dundee Ready Education Environment Measure (DREEM) for academic climate, and the SA-45 (Symptom Assessment-45 Questionnaire was used to assess psychopathological symptomatology.

RESULTS

The mean DREEM global score was low, 95.8 (SD 22.6). Worse perception of the academic climate has been found in females (t -2.21, p 0.027), in students of the clinical academic years (t 16.9, p < 0.001), and public medical schools ( t 15.6, p < 0.001). The SA45 general index score was high (p90) in 25.6% of participants. In respect of gender, female students presented higher levels of SA45 general index score, depression, interpersonal sensitivity, somatization, anxiety, obsession-compulsion, and phobic anxiety symptoms. Higher DREEM global and subscale scores corresponded to a higher SA-45 global index score and higher SA-45 subscale scores.

CONCLUSIONS

Our study suggests a correlation between a poor perception of academic climate, increased depression, anxiety, and other psychopathological symptoms, with a pattern that varies between different faculties. The perception of academic climate varied between medical schools, as did the psychopathological symptoms scores. Our finding suggests the prevalence of these variables in medical students is, at least in part, attributable to factors directly related to the learning atmosphere.

Examining the Effect of Virtual Learning on Canadian Pre-Clerkship Medical Student Well-Being During the COVID-19 Pandemic

Introduction

The restrictions of the COVID-19 pandemic resulted in the broad and abrupt incorporation of virtual/online learning into medical school curricula. While current literature explores the effectiveness and economic advantages of virtual curricula, robust literature surrounding the effect of virtual learning on medical student well-being is needed. This study aims to explore the effects of a predominantly virtual curriculum on pre-clerkship medical student well-being.

Methods

This study followed a constructivist grounded theory approach. During the 2020-2021 and 2021-2022 academic years, students in pre-clerkship medical studies at Western University in Canada were interviewed by medical student researchers over Zoom. Data was analyzed iteratively using constant comparison.

Results

We found that students experiencing virtual learning faced two key challenges: 1) virtual learning may be associated with an increased sense of social isolation, negatively affecting wellbeing, 2) virtual learning may impede or delay the development of trainees' professional identity. With time, however, we found that many students were able to adapt by using protective coping strategies that enabled them to appreciate positive elements of online learning, such as its flexibility.

Discussion

When incorporating virtual learning into medical education, curriculum developers should prioritize optimizing existing and creating new ways for students to interact with both peers and faculty to strengthen medical student identity and combat feelings of social isolation.

Impact of COVID-19 mitigations on anxiety and depression amongst university students: A systematic review and meta-analysis

Background

While much research has addressed mental health concerns related to the coronavirus disease 2019 (COVID-19) pandemic, there remains a scarcity of studies specifically exploring the changes in anxiety and depression among university students before and after the implementation of COVID-19 mitigation measures.

Methods

In this systematic review and meta-analysis, we searched databases including MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), ERIC (EBSCO), the WHO COVID-19 database, Scopus, and Science Citation Index (Web of Science) as of 15 February 2023. We included studies that used a validated tool to measure changes in anxiety or depression at two distinct time points - before (T1) and during (T2); during (T2) and after (T3); or before (T1) and after (T3) COVID-19 mitigation. The quality of studies was assessed using an adapted Joanna Briggs Institute Checklist for longitudinal studies. Utilising random-effects models, we synthesised changes in continuous outcomes as standardised mean difference (SMD) with 95% confidence interval (CI) and binary outcomes as risk difference (RD) with 95% CI.

Results

In total, 15 studies were included in this review, with eight of moderate and seven of high quality. In most of the included studies (n = 13), the majority of participants were women. Eleven studies analysed mental health outcomes between T1 and T2 of COVID-19 mitigations. Continuous symptom changes were a minimal or small improvement for anxiety (SMD = -0.03, 95% CI = -0.24 to 0.19, I2 = 90%); but worsened for depression (SMD = 0.26, 95% CI = -0.01 to 0.62). However, the proportions of students reporting moderate-to-severe symptoms, defined by specific cut-offs, increased during COVID-19 mitigation measures for both anxiety (RD = 0.17, 95% CI = -0.04 to 0.38, I2 = 95%) and depression (RD = 0.12, 95% CI = 0.03 to 0.22, I2 = 72%). Sensitivity analyses, which distinguished between baseline periods based on awareness of COVID-19, demonstrated an exacerbation of both symptoms when comparing the period before the global awareness of the COVID-19 outbreak (before December 2019) with the period during the implementation of mitigation measures.

Conclusions

Mental health outcomes, especially depressive symptoms, were observed to worsen in university students during COVID-19 mitigations. Despite considerable heterogeneity requiring careful interpretation of results, the impact of COVID-19 mitigations on mental health in university students is evident.

Registration

PROSPERO (CRD42021266889).

COVID and depression among stratified population groups: a narrative review

The Covid-19 pandemic has impacted and infiltrated every aspect of our lives. Successive lockdowns, social distancing measures, and reduction in economic activity have developed a new way of living and, in many cases, tend to lead to depression. The initial strict lockdown for about 3 months and eventually for a few more months has imposed greater challenges on children and adolescents in terms of psychological problems and psychiatric disorders. Regardless of their viral infection status, many people have been affected by the psychosocial changes associated with the Covid-19 pandemic. In the present review, we have attempted to evaluate the impact of COVID on the mental health of people from different age groups and occupations. The present review has highlighted the need for taking effective measures by the stakeholder to cope with depression among human population groups worldwide.

First-year Medical Students' Varying Vulnerability to Developing Depressive Symptoms and Its Predictors: a Latent Profile Analysis

OBJECTIVE

Previous meta-analytic data have demonstrated the propensity for mental morbidity among medical students (Rotenstein et al. JAMA. 2016;316(21):2214-36). However, there is a lack of research on medical students' varying depression vulnerabilities and predictive factors. The present study aims to gain a better understanding of the development of mental health morbidity and its predictive factors among first-semester medical students.

METHODS

In November 2020 and January 2021, 184 first-semester students from two medical schools were surveyed regarding depression (PHQ-9), self-efficacy, resilience, and cognitive self-regulation. Using latent profile analysis, we identified distinct depression development profiles. We applied a multinomial logistic regression analysis to determine how self-efficacy, resilience, and cognitive self-regulation and their changes predicted profile membership.

RESULTS

Five profiles of depression development were identified: profile 1, no depression (53.8%); profile 2, mild depression (26.1%); profile 3, depression increase I (9.2%); profile 4, depression increase II (9.8%); and profile 5, persistent depression (1.1%). Students with initially high self-efficacy, resilience, and cognitive self-regulation levels were more likely to belong to the no depression profile. A decrease in self-efficacy and cognitive self-regulation was associated with both depression increase profiles (profiles 3 and 4), and a decrease in resilience was found to be a predictor of profile 4.

CONCLUSION

Students who enter medical school have varying states of mental health, and they differ in their vulnerability to developing depressive symptoms. The promotion of resilience, self-efficacy, and cognitive self-regulation strategies may be key in preventing students' depression in the first semester of medical school.

Questions of Well-Being and Inclusion in Online Undergraduate Medical Education During COVID-19: A 2-Phased Focused Scoping Review

PURPOSE

Undergraduate medical education (UGME) was transformed by the rapid move to online curriculum delivery during the COVID-19 pandemic. Most research on online UGME has focused on measuring its effectiveness. However, medical educators also require evidence regarding its implications with respect to well-being and inclusion.

METHOD

To explore online learning transition, particularly the effect on well-being and inclusion, this 2-phased focused scoping review employed a revised Joanna Briggs Institute approach: (1) developing review questions and objectives; (2) determining eligibility criteria; (3) developing the search strategy; (4) extracting, analyzing, and discussing findings; (5) drawing conclusions; and (6) discussing implications for practice and further research.

RESULTS

The review ultimately included 217 articles, of which 107 (49%) explored student and staff well-being during online UGME, 64 (30%) focused on inclusion in this context, and 46 (21%) examined both well-being and inclusion. Additionally, 137 of included articles (63%) were research/evaluation, 48 (22%) were descriptive, and 32 (15%) were opinion. Of the 137 research/evaluation studies, 115 (84%) were quantitative, 10 (7%) were qualitative, 8 (6%) were mixed methods, and 4 (3%) were Reviews. Among these research/evaluation studies, the most commonly used data collection method was surveys (n = 120), followed by academic tests (n = 14). Other methods included interviews (n = 6), focus groups (n = 4), written reflections (n = 3), user data (n = 1), and blood tests (n = 1).

CONCLUSIONS

Important questions remain regarding the safety and inclusiveness of online learning spaces and approaches, particularly for members of historically excluded groups and learners in low-resource settings. More rigorous, theoretically informed research in online medical education is required to better understand the social implications of online medical education, including more in-depth, qualitative investigations about well-being and inclusion and more strategies for ensuring online spaces are safe, inclusive, and supportive.

The research on the impact of distance learning on students' mental health

The mental health of students learning online is a critical task for many countries around the globe. The research purpose was to analyse the factors affecting the quality of mental health of young individuals who learnt under conditions of not total lockdowns but adaptive quarantine restrictions. The research involved 186 volunteers from Zhengzhou University of Technology, 94 were first-year students, and 92 were fourth-year students. The experimental group involved first-year students, and the control group involved fourth-year students. An average age of the participants in the experimental group was 18.3 years, and in the control group, the average age was 22.4 years. The scholars conducted the research after four months of distance learning under the adaptive quarantine. The students could be involved in their usual entertainment activities and interpersonal communication outside the home. The Behavioural Health Measure, better known as BHM-20, was the core psychometric tool. The research finds that distance learning is less effective for first-year students than for fourth-year students because the former cannot effectively adapt and communicate in a new social environment, and develop trusting interpersonal relationships with fellow students and teachers. The research results coincide with other research on this issue and demonstrate a low degree of mental resilience during and after the pandemic. Previous research is not suitable for the analysis of the mental health of students under adaptive quarantine, including the freshmen, considered the most vulnerable group. The article will be useful for professionals interested in distance education in higher educational institutions, workers of socio-psychological services at universities or individuals involved in adapting curriculum materials for distance learning.

The link among academic stress, sleep disturbances, depressive symptoms, academic performance, and the moderating role of resourcefulness in health professions students during COVID-19 pandemic

Background

The rapid shift to virtual learning in response to the COVID-19 pandemic contributed to high academic stress among health profession students. High academic stress was associated with impaired psychosocial well-being and decreased academic performance.

Objectives

The purpose of this study was to assess the relationship between academic stress, anxiety, sleep disturbances, depressive symptoms, academic performance, and the moderating effect of resourcefulness among undergraduate health profession students.

Methods

This descriptive and cross-sectional study included undergraduate health profession students. The primary investigator distributed the study link to all students through the university's Central Messaging Centre, Twitter account, and WhatsApp. The study variables were measured using the Student Life Stress Inventory, the Generalized Anxiety Disorder-7 questionnaire, the Centre for Epidemiology Scale of Depression, the Pittsburgh Sleep Quality Index, and the Resourcefulness Skills Scale. Pearson R correlation and linear regression analysis were utilized for statistical analysis.

Results

Our sample included 94 undergraduate health profession students, 60 % of which were females with a mean age of 21, and the majority were nursing and medicine students. High academic stress, anxiety, sleep disturbances, depressive symptoms, and resourcefulness were reported among 50.6 %, 43 %, 79.6 %, 60.2 %, and 60 % of the participants, respectively. However, no effect of resourcefulness was found on any of the study variables. Instead, academic stress and sleep disturbances were the strongest predictors of depressive symptoms regardless of the level of resourcefulness.

Conclusion

Adequate academic support during virtual learning and tools to early detect subtle signs of high academic stress, anxiety, depression, and sleep disturbance should be routinely utilized by educational institutions. In addition, incorporating sleep hygiene and resourcefulness training in health professions education is highly indicated.

Implementation context and burnout among Department of Veterans Affairs psychotherapists prior to and during the COVID-19 pandemic

BACKGROUND

The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including organizational support for evidence-based psychotherapies, or EBPs) and pandemic-related stress (T2 only) on burnout.

METHOD

Psychotherapists providing EBPs for posttraumatic stress disorder in U.S. Department of Veterans Affairs (VA) facilities completed surveys assessing burnout, job resources, and job demands prior to (T1; n = 346) and during (T2; n = 193) the COVID-19 pandemic.

RESULTS

Burnout prevalence increased from 40 % at T1 to 56 % at T2 (p < .001). At T1, stronger implementation climate and implementation leadership (p < .001) and provision of only cognitive processing therapy (rather than use of prolonged exposure therapy or both treatments; p < .05) reduced burnout risk. Risk factors for burnout at T2 included T1 burnout, pandemic-related stress, less control over when and how to deliver EBPs, being female, and being a psychologist rather than social worker (p < .02). Implementation leadership did not reduce risk of burnout at T2.

LIMITATIONS

This study involved staff not directly involved in treating COVID-19, in a healthcare system poised to transition to telehealth delivery.

CONCLUSION

Organizational support for using EBPs reduced burnout risk prior to but not during the pandemic. Pandemic related stress rather than increased work demands contributed to elevated burnout during the pandemic. A comprehensive approach to reducing burnout must address the effects of both work demands and personal stressors.

The lived experiences of health science graduate students with anxiety and depression

Health science graduate programs are intensive experiences in students' lives which can contribute to perceived symptoms of anxiety and/or depression. The consequent impact of these symptoms can have an overall effect on the graduate students' ability to participate in their daily lives, along with their program of study. The purpose of this study was to understand the lived experiences of health science graduate students who experience perceived signs and symptoms of anxiety and/or depression. An open-ended, qualitative phenomenological survey was used to understand the experiences of 56 Doctor of Occupational Therapy, Doctor of Physical Therapy, and Doctor of Pharmacy students at a university in the southeastern United States. Three themes were identified from the data: the cyclic effect of symptoms and triggers; the importance of support systems; and the benefit of coping skill utilization. Future research is needed to understand the effects of preventive and rehabilitative measures to address health science graduate students' mental health.

Psychological Impact of the 2022 Round COVID-19 Pandemic on China's College Students

In response to the new round of COVID-19 outbreaks since March 2022, universities with high outbreak rates around the country have taken quarantine measures to contain the epidemic. Evidence from previous coronavirus outbreaks has shown that people under quarantine are at risk for mental health disorders. To better understand the impacts of this round of COVID-19 quarantine on domestic college students and their responses, we conducted a systematic survey to assess the stress and anxiety, and to evaluate effective measurements in this population. We searched relevant documents and literature, and designed a questionnaire from six aspects, including psychological status, epidemic situation, study, daily life, sports, and interpersonal communication, with 51 items in total. We sent the questionnaire on the Wenjuanxing Web platform, from April 2 to 8, 2022. We evaluated the mental status according to parts of the Generalized Anxiety Disorder-7 (GAD-7) and Depression Anxiety Stress Scales-21 (DASS-21), and investigated the influencing risk factors and countermeasures. Statistical analysis was performed by using the Chi-square test and multi-variable logistic regression. In total, 508 college respondents were recruited in our survey, and the pooled prevalence of mild anxiety (GAD score ≽ 5, or DASS-21 anxiety score ≽ 8) or stress (DASS-21 pressure score ≽ 14) caused by the new round of COVID-19 pandemic quarantine was 19.69% (100/508). The prevalence of the anxiety or stress in college students with COVID-19 quarantine between different genders, regions, and majors was not significantly different. Independent risk factors for the mild anxiety or stress of undergraduates by COVID-19 quarantine included learning efficiency or duration [OR = 1.36, 95%CI (1.14-1.62), P = 0.001], based on the combined analysis of Chi-square test analysis with multi-variable logistic regression analysis. Interestingly, the mental well-beings before COVID-19 epidemic quarantine [OR = 0.22, 95%CI (0.13-0.36), P < 0.0001], more low-intensity exercise [OR = 0.36, 95%CI (0.15-0.87), P = 0.02, high-intensity exercise as reference], and good sleep quality [OR = 0.14, 95%CI (0.07-0.30), P < 0.0001: OR = 0.42, 95%CI (0.30-0.59), P < 0.0001] are protective factors for alleviating the quarantine-caused anxiety or stress in Chinese college students for this round of COVID-19 epidemic quarantine. During the round of COVID-19 epidemic quarantine in 2022, a small number of college students have mild anxiety, affected by decreased learning efficiency or duration, which could be mitigated with low-intensity exercise and good sleep quality.

Study-related wellbeing, behavior, and attitudes of university students in the Netherlands during emergency remote teaching in the context of COVID-19: A longitudinal study

Introduction

During the COVID-19 pandemic, emergency remote teaching was implemented at all conventional Dutch universities; however, the degree of limitations in on-campus teaching and learning varied during the pandemic dependent on the strictness of the measures. In the present study, it will be investigated how study-related experiences of university students changed in the face of varying limitations in on-campus teaching and learning.

Methods

The study had a longitudinal natural experiment design with three points of measurement during the academic year 2020-2021: November-December 2020 (t1; campuses partially open), March 2021 (t2; campuses fully closed) and June-July 2021 (t3; campuses partially open). In total, 680 Dutch university students (65.9% female; age: M = 21 years, SD = 2.06) filled in online surveys measuring study-related wellbeing (academic burnout and study-engagement), study-related behavior (study effort), and study-related attitudes (education satisfaction, online self-efficacy, and attitudes toward online education).

Results

Overall, students reported moderate levels of academic burnout, study engagement, study effort, education satisfaction, and online self-efficacy; their attitudes toward online education were rather negative. Students' study-related wellbeing and education satisfaction decreased in the period when on-campus teaching and learning was impossible (t2) compared to periods in which on-campus teaching and learning was possible at a low level with several restrictions (t1 and t3). Students' attitudes toward online education and online self-efficacy slightly increased at the end of the academic year (t3); however, the attitudes toward online education remained negative.

Discussion

The findings indicate that students' academic burnout, study engagement, and education satisfaction varied over the course of the academic year in the context of changing limitations in on-campus teaching and learning. To facilitate positive study-related experiences, universities are advised to offer as much on-campus education as possible in times of pandemics.

The mediating role of general academic emotions in burnout and procrastination among Chinese medical undergraduates during the COVID-19 pandemic: A cross-sectional study

Background

Academic procrastination has become more prevalent during the COVID-19 pandemic due to teaching/learning changes. This phenomenon induces academic burnout, which is already serious among medical students. However, the academic emotion, which is the factor most vulnerable to changes in the academic environment, is still unknown. Therefore, the current study aimed to investigate the mediating role of general academic emotions in procrastination and burnout among Chinese medical students during the COVID-19 pandemic.

Methods

This cross-sectional study enrolled 995 medical students from China Medical University. We applied the Chinese version of the Maslach Burnout Inventory Student Survey (MBI-SS), the Aitken Procrastination Inventory (API) and the General Academic Emotion Questionnaire for College Students (GAEQ) to evaluate the variables of interest. We examined the mediation effects of GAEs by hierarchical linear regression analysis.

Results

Correlation analyses showed a significant positive correlation between procrastination and burnout. Procrastination and burnout positively and negatively correlated with negative academic emotions, respectively. Hierarchical linear regression analyses showed that procrastination had positive associations with negative academic emotions, while it had negative associations with positive academic emotions. The contributions (as mediators) of GAEs to burnout and procrastination were 21.16% (NAEs), 29.75% (PAEs), 54.25% (NDEs) and 23.69% (PDEs).

Conclusions

The results indicate that academic emotions had mediating effects on procrastination and burnout. Medical students' worries about the uncertainty of the learning environment may have exacerbated academic burnout. Targeted improvements in the teaching environment to communicate encouragement and reduce anxiety and helplessness among medical undergraduates for implementing medical education while preventing and controlling the infection.

Perception of Current Educational Environment, Clinical Competency, and Depression among Malaysian Medical Students in Clinical Clerkship: A Cross-Sectional Study

The COVID-19 pandemic has altered the educational environment of medical students in clinical clerkship, with potential impacts on clinical competency and reported increased prevalence of depression. This study aimed to determine the relationship between the perception of the educational environment, self-perceived clinical competency, and depression among them. Subjects (N = 196) at the National University of Malaysia participated through convenience sampling in an online survey including sociodemographic data, COVID-19-related stressors, Dundee Ready Education Environment Measure (DREEM), self-perceived clinical competency, and Patient Health Questionnaire (PHQ-9). The cut-off point for depression was a PHQ-9 score ≥ 15. Multiple logistic regression followed bivariate analyses to identify factors for depression. The participants (mean age: 23.2 years, SD ± 0.98 years) were mainly female (71.9%) and Malay (59.2%). The prevalence of depression was 17.4% (95% CI: 12.3-23.4%). Most participants perceived the educational environment positively. In logistic regression, ethnicity (Adjusted OR = 3.1, 95% CI: 1.2-8.1) and DREEM score were significantly associated with depression, whereas self-perceived clinical competency was not. A higher DREEM score indicating a better perception of the educational environment was linked to a lower likelihood of depression (p = 0.046). Besides ethnicity, perception of the educational environment emerged as a factor associated with depression. This relationship between the educational environment and mental well-being warrants further exploration.

Online programs to strengthen the mental health of medical students: A systematic review of the literature

Medical students have been shown to be vulnerable to mental stress. Strengthening individual protective characteristics can be one cornerstone for promoting medical students' mental health and thereby preventing mental disorders. Online programs are an opportunity to provide appropriate options that have the advantage of being accessible from anywhere, at any time, and with a low entry threshold. This review provides a literature overview of current online programs for medical students. The findings can serve as a point of reference for designing effective online programs for mental health-promotion and mental disorder-prevention in medical curricula. We applied a systematic literature search in PubMed, ERIC, Cochrane, and Web of Science. Programs offered had to be web-based, and the addressed group had to be medical students. Protective individual characteristics for mental health and information on the programs' effectiveness were included in the search. As outcomes, we included mental health, burnout, symptoms of depression, anxiety, and well-being. The search yielded 723 articles; of them, 11 met the inclusion criteria. Programs found were grouped according to their focus: mental health literacy, mindfulness, based on Cognitive Behavioral Therapy, or peer support. Two studies showed significant reductions in perceived stress; one study indicated reduced burnout levels. One program had significant immediate effects on mindfulness, empathy, and resilience; two studies indicated strengthening coping strategies. Two programs were qualitatively assessed as helpful; two studies are ongoing. Nine studies lacked control groups; two randomized controlled trials were ongoing. Only a few online programs with limited evidence of effectiveness were found. They addressed protective individual characteristics, highlighting their importance for mental health. Thus, more health-promoting and mental disorder-preventing programs with high-quality effectiveness studies are necessary. An integration of such programs into curricula would allow for greater utilization and could give greater emphasis to and prioritize mental health in medical education.

The Consequences of the Pandemic on Medical Students’ Depressive Symptoms and Perceived Stress: A Repeated Cross-Sectional Survey with a Nested Longitudinal Subsample

This study aimed to explore the impact of the pandemic on medical students’ mental health in Italy using a repeated cross-sectional survey with a nested longitudinal subsample (first timepoint: 2018; second: 2020/2021). Three research questions (RQs) were investigated. Study 1 (longitudinal sub-sample) explored whether medical students had higher levels of depressive symptoms and stress during the pandemic compared with a pre-pandemic period (RQ1) and what variables were associated with these conditions during the pandemic adjusting for baseline levels (RQ2). Study 2 (repeated cross-sectional data) aimed to examine whether medical students had higher levels of these conditions during the pandemic compared with their same-year peers during a pre-pandemic period (RQ3). In Study 1, higher levels of depressive symptoms and stress were shown during the pandemic (RQ1). Multivariable models highlighted associations between poor mental health and worsening of the judgment of medical school choice, worsened psychological condition due to the pandemic, economic repercussions due to the pandemic, and baseline levels of symptoms (RQ2). In Study 2, our findings reported higher levels of depressive symptoms and stress during the pandemic, also adjusting for other variables (RQ3). In conclusion, depressive symptoms and stress were greater during the pandemic. The most relevant variables were pandemic-related items and medical school choice judgment.

The Association between COVID-19 Pandemic and the Quality of Life of Medical Students in Silesian Voivodeship, Poland

(1) Background: Since the COVID-19 pandemic spread rapidly in 2020, medical universities have been affected by a particular crisis. Due to the increased risk of SARS CoV-2 transmission, the authorities of medical faculties all over the world, including Poland, started to minimize direct contact between students. The objective of the paper is to identify and assess determinants of the quality of life among medical students in Poland before and during the COVID-19 pandemic. (2) Methods: We analyzed data obtained in a cross-sectional study performed among three groups of students tested in three consecutive research periods: period before the COVID-19 pandemic, the COVID-19 pandemic lockdown period and the COVID-19 pandemic period following lockdown. (3) Results: The total number of participants was 1098. We identified that the research period before the COVID-19 pandemic was the risk factor for lower quality of life in terms of the somatic and environmental domains. It was also confirmed that determinants such as poor financial situation, low frequency of physical activity and bad self-declared health status harmed the QoL scores in all domains. (4) Conclusions: The obtained results confirmed that better financial situation, higher physical activity and better self-declared health status were statistically significant factors improving the quality of life of first-year medical students in Poland. The findings of our study also showed that the declared somatic and environmental domains of QoL among medical students were better during the COVID-19 pandemic period. Our observations confirmed that the immediate implementation of e-learning could protect against the deterioration of mental health and quality of life in first-year medical students during possible future epidemic crises.

Empathy alleviates the learning burnout of medical college students through enhancing resilience

OBJECTIVE

The problem of learning burnout of medical students is becoming prominent, and empathy can play a good predictive role in learning burnout. The present study aimed to investigate the relationship between empathy and learning burnout, as well as the mediation effect of resilience in this relation.

METHODS

Five hundred and eighty-eighth college students from a key medical university in Yunnan Province was investigated using the Basic Empathy Scale, Learning Burnout Scale, and Connor-Davidson Resilience Scale. All the measures showed good reliability and validity in the present study. Data were analyzed using SPSS 23.0 and Amos 22.0.

RESULTS

Using structural equation modeling, we tested a conceptual model indicated that: (1) medical students' empathy negatively and significantly predicted learning burnout; (2) medical students' empathy positively predicts mental resilience; (3) resilience of medical students negatively predicts learning burnout; (4) resilience partially mediated the relationship between empathy and learning burnout of medical students, while also controlling for family socioeconomic status.

CONCLUSION

These findings highlight the mediating role of resilience in the effect of empathy on learning burnout of medical college students. It may contribute to a better understanding of the effect of empathy. Moreover, it can also provide constructive suggestions for protecting and improve empathy and resilience of medical college students.

First-Year College Students' Mental Health in the Post-COVID-19 Era in Guangxi, China: A Study Demands-Resources Model Perspective

The post-COVID-19 era means that the COVID-19 is basically under control; however, the risk of the pandemic still affects people's work, study, and life, physically and psychologically. In this era, due to the more challenges first-year college students face, more attention should be paid to their mental health. An emerging study demands-resources (SD-R) model can explain the influencing mechanism of college students' mental health. This model suggests that study demands increase the risk of student burnout, which results in mental health problems; meanwhile, study resources reduce student burnout and increase student engagement, thus improving mental health. Based on the SD-R model, this study explores the impacts of time pressure, emotional exhaustion, perceived social support, and student engagement on mental health and provides adequate measures to reduce the risk of mental health problems among first-year students. Time pressure, perceived social support, emotional exhaustion, student engagement, and mental health scales were used to investigate 537 first-year students at three universities in Guangxi, China, of whom 290 (54%) were female, and 247 (46%) were male, and the average age was 18.97 ± 1.01. Results indicated that: (1) Moderate scores on time pressure and emotional exhaustion and slightly-above-the-median scores on perceived social support, student engagement, and mental health were found among first-year students in the post-COVID-19 era. (2) Time pressure had a positive relationship with emotional exhaustion and a negative relationship with mental health. (3) Perceived social support was negatively correlated with emotional exhaustion but positively correlated with student engagement, and thus improved mental health. Results of this study with a sample of first-year college students in China support the hypotheses based on the SD-R model. These findings suggest that increasing perceived social support and student engagement while decreasing time pressure and emotional exhaustion may promote mental health among first-year college students.

IMPROVing communication about diversity, equity, and inclusion in health professions education

There has never been a stronger call for authenticity in health professions education than this moment in time. The health inequities laid bare by the COVID-19 syndemic (a concept that describes the clustering of SARS-CoV-2 infection and disease by political, social, and economic factors) compels health professions educators to learn how to best engage in, sustain, and deepen conversations on diversity, equity, and inclusion (DEI) within our learning environments. Health professions curricula should address such concerns through explicit faculty training programs in dialogue models of communication. In this commentary, I propose that medical improv can help refocus health professions training to the humanistic values of empathy for others and respect for multiple viewpoints. Medical improv refers to teaching methods that adapt improvisation principles and exercises to enhance professional competencies in the health professions, such as communication. I describe a training series implemented at one institution to prepare faculty facilitators to engage in conversations about DEI in a discussion-based core course on the social determinants of health for first year medical students called "Humanity in Medicine." Key elements of dialogue training, including examinations of identity and positionality, caretaking and team-making, and conversations with a skeptic, are viewed through the lens of improv exercises as a pedagogy in communication. I report on facilitator and medical students' positive response to facilitator training and the Humanity in Medicine course. Potential next steps towards a formal evaluation of the method, and outcomes assessments of the use of improv in health professions training are discussed.

Pre-medical students' perceptions of educational environment and their subjective happiness: a comparative study before and after the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic necessarily changed pre-medical students' educational environment into an online format-and students' subjective happiness (SH) is highly impacted by their educational environment. This study investigates changes in pre-medical students' perceptions of their educational environment and their SH before and after the pandemic, as well as explores the predictors related to their SH.

METHODS

The Korean version of the Dundee Ready Educational Environment Measure (DREEM) questionnaire and single-item measures of SH and professional identity (PI) were used. The t-test was employed to analyze the differences of the SH, PI, and DREEM subscales scores before and after the onset of COVID-19. Cohen's d was used as effect size and correlations between SH and different subscales of DREEM were analyzed using Pearson's correlation. The multiple regression analysis was performed to reveal associations between predictors and SH.

RESULTS

A total of 399 pre-medical students completed the survey both before and after the COVID-19 pandemic. The DREEM scores and all subscales scores significantly increased but each presents a different effect size. Students' Perceptions of Learning (SPL: Cohen's d = 0.97), Students' Perceptions of Teaching (SPT: Cohen's d = 1.13), and Students' Perceptions of Atmosphere (SPA: Cohen's d = 0.89) have large effect sizes. Students' Academic Self-Perceptions (SASP: Cohen's d = 0.66) have a medium effect size and Students' Social Self-Perceptions (SSSP: Cohen's d = 0.40) have a small effect size. In contrast, no significant change was noted in the SH and PI. Both PI and SSSP impacted SH before COVID-19, but after the pandemic, SH was impacted by SPL, SPA, and SSSP.

CONCLUSIONS

Students' overall perception of their educational environment was more positive after the onset of COVID-19, but their social self-perceptions improved the least. Additionally, SSSP is the only predictor of SH both before and after the pandemic. The findings of this study suggest that educational institutions must pay attention to students' social relationships when trying to improve their educational environment. Furthermore, so as to increase students' SH, development of both educational environment and PI is essential.

Impact of COVID-19 Pandemic on Undergraduate Psychiatry Teaching, Educational Environment, and Learning Processes

PURPOSE

The COVID-19 pandemic has brought about significant changes in the way undergraduate medical education is conducted including psychiatry teaching. In view of sparse data on how the perception of the undergraduate educational environment (EE) is affected by the pandemic, we sought to compare the ratings of EE and learning processes (motivation, engagement, equipping, appreciation of psychiatry) between the 2020 (during pandemic) and 2019 (before pandemic) cohorts of students, and examined how the perception of the EE would influence overall experience within the psychiatry rotation.

PATIENTS AND METHODS

The DREEM (Dundee Ready Education Environment Measure) was administered to fourth-year medical undergraduate students undergoing a psychiatry rotation in 2020 during the pandemic and these ratings were compared with those of the preceding cohort in 2019. Students also completed five additional items evaluating various learning processes and overall rating of the posting. Relationships between the DREEM scores, learning processes, and overall effectiveness of rotation were assessed using correlation and mediational analyses.

RESULTS

Altogether, 84 (response rate 93.3%) and 269 (response rate 89.7%) medical undergraduates participated in the study from 2020 and 2019 cohorts, respectively. The 2020 cohort had higher scores on the total DREEM (p = 0.032), academic self-perception DREEM subscale (p = 0.002), felt more engaged (p = 0.043) and better equipped (p = 0.003) compared with the 2019 cohort. Overall, DREEM and subdomain scores correlated significantly with specific learning processes. The direct effect of total DREEM and overall rating of psychiatry posting was significant in mediational analyses.

CONCLUSION

Our results highlighted that students' perception of the EE remained positive during the pandemic and impacts overall experience of the psychiatry posting. Undergraduate psychiatry training should continually seek to enhance the EE so as to optimize learning through better engagement and equipping of the learners even during the pandemic.

Impact of COVID-19 on the Mental Health of Medical Students in Portugal

(1) Background: The purpose of this article is to assess the impact of the COVID-19 pandemic on the mental health of medical students in Portugal in the period after returning to face-to-face classes during the COVID-19 pandemic, in the 2020/2021 academic year. (2) Methods: We conducted an observational, descriptive, and cross-sectional study, between December 2020 and February 2021 with a representative sample of Portuguese medical students (n = 649), applying an anonymous questionnaire which was composed by a sociodemographic characterization, The Brief Symptoms Inventory-18, The Fear of COVID-19 Scale and the Negative Impact Assessment Scale. For statistical processing, Statistical Package for Social Sciences (SPSS ©) was used. (3) Results: 65.3% of participants said that self-perceived relevant anxiety symptoms, and around 10% said that they had a physical or a mental illness diagnosis. Significant differences (p < 0.05) were found for Fear of COVID-19, Somatization, Anxiety and Overall Mental Health, indicating that women, students from the 1st and last years of training had higher scores. Age, year of training, Fear of COVID-19 and Negative Impact of COVID-19 were significant predictors of overall mental health. (4) Conclusion: In our sample of Portuguese medical students, age, year of training, but mostly fear of COVID-19 and the negative impact of COVID-19 contributed to mental health symptoms.