A prospective study of the factors associated with life quality during medical internship

The challenges of medical students in their internship : a qualitative study from Iran

BACKGROUND AND OBJECTIVES

Medical students experience different types of challenges during their MD program, which become more challenging when it comes to the internship, putting too much pressure on them. This study aimed to explore the challenges of medical interns of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran.

METHODS

In this qualitative research, which was conducted from September 2023 March 2024, medical interns of SUMS were selected using purposeful sampling method. The data were collected through deep and semi-structured interviews, and it was continued until data saturation was achieved. The data analysis was performed through thematic content analysis.

RESULTS

A total of 13 participants (6 men and 7 women) with a mean ± SD age of 25 ± 1.6 years were interviewed. The challenges of medical interns consisted of 423 meaning units, 79 open codes, 14 subthemes, and 6 main themes; the main themes consisted of educational challenges, challenges following university regulations, health and behavioral issues, economic/employment-related issues, sociocultural and recreational challenges, and ethical issues.

CONCLUSION

The results of this study highlight the necessity for reforms in the medical internship phase aiming to tackle interns' issues and establish a supportive and nurturing environment for future medical doctors.

Sleep, mental health and physical health in new shift workers transitioning to shift work: Systematic review and meta-analysis

This systematic review and meta-analysis (PROSPERO registration CRD42022309827) aimed to describe how shift work impacts new workers' sleep, mental health, and physical health during the transition to shift work and to consolidate information regarding predictors of shift work tolerance (SWT) during this transition period. Inclusion criteria included: new shift workers; sleep, mental health, or physical health outcomes; prospective study design with the first timepoint assessing workers within three months of starting shift work; and written in English. Searches from six databases returned 12,172 articles as of August 2023. The final sample included 48 papers. Publication quality and risk of bias was assessed using the critical appraisal skills program. Forty-five studies investigated longitudinal changes in sleep, mental health, or physical health outcomes and 29 studies investigated predictors of SWT (i.e., better sleep, mental and physical health). Sleep and mental health outcomes worsened following the onset of shift work, while physical health did not significantly change. Pre-shift work mental health, sleep, and work characteristics predicted SWT later in workers' careers. Shift work adversely impacts new workers' sleep and mental health early in their career, and interventions before beginning shift work are needed to promote better SWT.

The role of chronic physical illness and job dissatisfaction on burnout’s risk among medical interns in Oman: a study of prevalence and determinants

Background

Medical interns are at risk of burnout due to several organizational and individual factors. There is scarcity of studies exploring the role of chronic physical illness and job dissatisfaction on burnout experience among medical interns. This study examined the prevalence of burnout syndrome and explored whether chronic physical illness and job dissatisfaction could independently predict burnout syndrome among medical interns in Oman. This cross-sectional study was conducted among a random sample of medical interns enrolled in the Omani internship program. One-hundred and eighty interns participated in this study and filled in a self-reported questionnaire that included Maslach Burnout Inventory (MBI), Job Satisfaction Survey (JSS), and data related to physical illness.

Results

The prevalence of burnout syndrome was 15%. Having a physical illness (OR = 7.285, 95% CI = 1.976–26.857, P = 0.003) and job dissatisfaction (OR = 16.488, 95% CI = 5.371–50.614, P = 0.0001) was significant independent predictors of high levels of the EE subscale. In addition, having a physical illness (OR = 4.678, 95% CI = 1.498–14.608, P = 0.008) and being dissatisfied (OR = 2.900, 95% CI = 11.159–7.257, P = 0.023) were significant independent predictors of the high DP subscale. Having physical illness was independent predictors of the low personal accomplishment subscale (OR = 0.258, 95% CI = 0.088–0.759, P = 0.014).

Conclusions

Burnout syndrome is prevalent among medical interns in Oman. Job dissatisfaction and chronic physical illness are risk factors for burnout syndrome. Internship programs should consider these factors when designing burnout mitigative strategies.

Development of Digital Biomarkers of Mental Illness via Mobile Apps for Personalized Treatment and Diagnosis

The development of precision psychiatry is largely based on multi-module measurements from the molecular, cellular, and behavioral levels, which are integrated to assess neurocognitive performances and clinically observed psychopathology. Nevertheless, quantifying mental activities and functions accurately and continuously has been a major difficulty within this field. This article reviews the latest efforts that utilize mobile apps to collect human–smartphone interaction data and contribute towards digital biomarkers of mental illnesses. The fundamental principles underlying a behavioral analysis with mobile apps were introduced, such as ways to monitor smartphone use under different circumstances and construct long-term patterns and trend changes. Examples were also provided to illustrate the potential applications of mobile apps that gain further insights into traditional research topics in occupational health and sleep medicine. We suggest that, with an optimized study design and analytical approach that accounts for technical challenges and ethical considerations, mobile apps will enhance the systemic understanding of mental illnesses.

Quality of life of veterinary residents in AVMA-Recognized Veterinary Specialty Organizations using the WHOQOL-BREF instrument

Objective

To assess whether there is an association between veterinary specialty and the quality of life of residents in AVMA-Recognized Veterinary Specialty Organizations^™ using the WHOQOL-BREF instrument.

Methods

This cross-sectional study used an online survey and data collection service for administration of the survey to veterinary residents during April 2021 to June 2021. Veterinary residents were contacted through their respective AVMA-Recognized Veterinary Specialty Organization^™ and through social media. Overall quality of life along with the domains of Physical Health, Psychological Health, Social Relationships, and Environment were measured using the WHOQOL-BREF instrument. Additionally, data on the demographics of participants were collected and investigated as potential confounders. Mean standardized scores (0 to 100) were compared among the specialties using the general linear model.

Results

792 residents from 21 veterinary specialties were included in the analysis. The results showed that overall quality of life and all four domains varied significantly among specialties after adjusting for significant demographic variables (all Ps < 0.001). The mean standardized overall quality of life score was 54.3, ranging from 31.8 in Emergency and Critical Care to 56.3 in Laboratory Animal. The mean standardized quality of life scores were lowest for Psychological Health (50.3), followed by Social Relationships (55.0), Environment (61.4), and Physical Health (62.6). Residents in Emergency and Critical Care had the lowest adjusted average scores in all quality of life domains. Residents in Internal Medicine, Anesthesia and Analgesia, and Surgeons had lower quality of life scores across several domains when compared to other specialties.

Clinical relevance

This study provides insight into the mental health and general well-being of veterinary residents. The results can assist veterinary specialty organizations, universities, and mentors in developing appropriate supporting programs for residents. The results can also assist residents in recognizing and more efficiently caring for their individual mental health and well-being.

The price of internship through COVID-19: 1st year physicians report substantial mental health symptoms during the pandemic

OBJECTIVES

To examine the prevalence of mental health symptoms among medical interns working for the first time as physicians in a large tertiary hospital in Israel during the 1st COVID year.

METHODS

All interns who worked for at least 2 months during the 1st COVID year (March 2020-February 2021) at the Tel-Aviv Sourasky Medical Center (TASMC), a large tertiary general hospital in Israel were approached simultaneously during April-May 2021, and were requested to fill in an online survey. In each questionnaire, the interns were asked to refer to the worst time they endured the symptoms described. Included were all medical. Depression and anxiety symptoms, post-traumatic stress symptoms and Burnout measures were evaluated using validated questionnaires. Depressive/anxiety symptoms were defined as primary end measures. We assessed the association between depression and anxiety symptoms, and demographic, post-traumatic and burnout measures.

RESULTS

145 out of 188 interns completed the study (77% overall response rate). The mean age was 30.36 ± 2.97. Almost half the interns (47%) reported depression/anxiety symptoms. The high depression/anxiety group was characterized by a lower mean age (29.87 ± 2.93 vs. 30.92 ± 2.91, p = 0.041), higher post-traumatic symptoms (15.62 ± 13.32 vs. 3.63 ± 5.59, p < 0.0001) and higher scores in 2/3 burnout subscales - emotional exhaustion (5.09 ± 1.29 vs. 3.61 ± 1.38, p = 0.000001) and depersonalization (3.83 ± 1.71 vs. 2.94 ± 1.46, p = 0.002). 11.4% of interns in the full sample reported they used cannabis or alcohol as "self-medication".

CONCLUSIONS

medical interns serving for their first year as physicians during the COVID pandemic, developed mental symptoms in alarming numbers. The findings point to a crucial need to implement active interventions to protect these doctors, so that they can safely embark on their medical careers, specifically in times of global health crises.

Assessing Physicians' Recall Bias of Work Hours With a Mobile App: Interview and App-Recorded Data Comparison

Background

Previous studies have shown inconsistencies in the accuracy of self-reported work hours. However, accurate documentation of work hours is fundamental for the formation of labor policies. Strict work-hour policies decrease medical errors, improve patient safety, and promote physicians’ well-being.

Objective

The aim of this study was to estimate physicians’ recall bias of work hours with a mobile app, and to examine the association between the recall bias and physicians’ work hours.

Methods

We quantified recall bias by calculating the differences between the app-recorded and self-reported work hours of the previous week and the penultimate week. We recruited 18 physicians to install the “Staff Hours” app, which automatically recorded GPS-defined work hours for 2 months, contributing 1068 person-days. We examined the association between work hours and two recall bias indicators: (1) the difference between self-reported and app-recorded work hours and (2) the percentage of days for which work hours were not precisely recalled during interviews.

Results

App-recorded work hours highly correlated with self-reported counterparts (r=0.86-0.88, P<.001). Self-reported work hours were consistently significantly lower than app-recorded hours by –8.97 (SD 8.60) hours and –6.48 (SD 8.29) hours for the previous week and the penultimate week, respectively (both P<.001). The difference for the previous week was significantly correlated with work hours in the previous week (r=–0.410, P=.01), whereas the correlation of the difference with the hours in the penultimate week was not significant (r=–0.119, P=.48). The percentage of hours not recalled (38.6%) was significantly higher for the penultimate week (38.6%) than for the first week (16.0%), and the former was significantly correlated with work hours of the penultimate week (r=0.489, P=.002)

Conclusions

Our study identified the existence of recall bias of work hours, the extent to which the recall was biased, and the influence of work hours on recall bias.

The prevalence of burnout among interns in Riyadh, Saudi Arabia, and its relation to engaging in unethical behaviors

Background

Burnout is a work-related physical and/or emotional exhaustion among individuals working in the human service sector. This descriptive cross-sectional study aimed to estimate the prevalence of burnout among interns training in different hospitals in Riyadh, Saudi Arabia, and its relation to engaging in unethical behaviors.

Results

The study found a high burnout level in 135 (50%) of the interns with minimal overall engagement in unethical behaviors (5.9%). However, patient-related burnout was the only factor found with a highly significant association to engagement in unethical behaviors (P-value < 0.001).

Conclusions

This study demonstrated a high prevalence of burnout among interns with a significant association between patient-related burnout and the engagement in unethical behaviors. That was a worrying sign that needs further evaluation in future research, including the other risk factors, to prevent/improve burnout and to limit the unprofessional behaviors.

Assessing User Retention of a Mobile App: Survival Analysis

BACKGROUND

A mobile app generates passive data, such as GPS data traces, without any direct involvement from the user. These passive data have transformed the manner of traditional assessments that require active participation from the user. Passive data collection is one of the most important core techniques for mobile health development because it may promote user retention, which is a unique characteristic of a software medical device.

OBJECTIVE

The primary aim of this study was to quantify user retention for the "Staff Hours" app using survival analysis. The secondary aim was to compare user retention between passive data and active data, as well as factors associated with the survival rates of user retention.

METHODS

We developed an app called "Staff Hours" to automatically calculate users' work hours through GPS data (passive data). "Staff Hours" not only continuously collects these passive data but also sends an 11-item mental health survey to users monthly (active data). We applied survival analysis to compare user retention in the collection of passive and active data among 342 office workers from the "Staff Hours" database. We also compared user retention on Android and iOS platforms and examined the moderators of user retention.

RESULTS

A total of 342 volunteers (224 men; mean age 33.8 years, SD 7.0 years) were included in this study. Passive data had higher user retention than active data (P=.011). In addition, user retention for passive data collected via Android devices was higher than that for iOS devices (P=.015). Trainee physicians had higher user retention for the collection of active data than trainees from other occupations, whereas no significant differences between these two groups were observed for the collection of passive data (P=.700).

CONCLUSIONS

Our findings demonstrated that passive data collected via Android devices had the best user retention for this app that records GPS-based work hours.

Cardiac Autonomic Modulation during on-Call Duty under Working Hours Restriction

Background: Medical residency is a time of high stress and long working hours, which increase the risk of cardiovascular disease. This study aimed to investigate the autonomic modulation of resident physicians throughout the on-call duty cycle. Methods: Spectral analysis of heart rate variability (HRV) was used to compute cardiac parasympathetic modulation (high-frequency power, HF) and cardiac sympathetic modulation (normalized low-frequency power, LF%, and the ratio of LF and HF, LF/HF) of 18 residents for a consecutive 4-day cycle. Results: Male residents show reduced cardiac sympathetic modulation (i.e., higher LF/HF and LF%) than the female interns. Medical residents’ cardiac parasympathetic modulation (i.e., HF) significantly increased on the first and the second post-call day compared with the pre-call day. In contrast, LF% was significantly decreased on the first and the second post-call day compared with the pre-call day. Similarly, LF/HF was significantly decreased on the second post-call day compared with the pre-call day. LF/HF significantly decreased on the first post-call day and on the second post-call day from on-call duty. Conclusion: The guideline that limits workweeks to 80 h and shifts to 28 h resulted in reduced sympathetic modulation and increased parasympathetic modulation during the two days following on-call duty.