Psychological stress in first year medical students in response to the dissection of a human corpse

A scoping review of emotions and related constructs in simulation-based education research articles

BACKGROUND

While acknowledgement of emotions' importance in simulation-based education is emerging, there are concerns regarding how education researchers understand the concept of emotions for them to deliberately incorporate emotionally charged scenarios into simulation-based education. This concern is highlighted especially in the context of medical education often lacking strong theoretical integration. To map out how current simulation-based education literature conceptualises emotion, we conducted a scoping review on how emotions and closely related constructs (e.g. stress, and emotional intelligence) are conceptualised in simulation-based education articles that feature medical students, residents, and fellows.

METHODS

The scoping review was based on articles published in the last decade identified through database searches (EMBASE and Medline) and hand-searched articles. Data extraction included the constructs featured in the articles, their definitions, instruments used, and the types of emotions captured. Only empirical articles were included (e.g. no review or opinion articles). Data were charted via descriptive analyses.

RESULTS

A total of 141 articles were reviewed. Stress was featured in 88 of the articles, while emotions and emotional intelligence were highlighted in 45 and 34 articles respectively. Conceptualisations of emotions lacked integration of theory. Measurements of emotions mostly relied on self-reports while stress was often measured via physiological and self-report measurements. Negative emotions such as anxiety were sometimes seen as interchangeable with the term stress. No inferences were made about specific emotions of participants from their emotional intelligence.

CONCLUSIONS

Our scoping review illustrates that learners in simulation-based education are most often anxious and fearful. However, this is partially due to medical education prioritising measuring negative emotions. Further theoretical integration when examining emotions and stress may help broaden the scope towards other kinds of emotions and better conceptualisations of their impact. We call for simulation education researchers to reflect on how they understand emotions, and whether their understanding may neglect any specific aspect of affective experiences their simulation participants may have.

Medical students' coping with stress and its predictors: a cross-sectional study

Objectives

To analyse stress coping styles of medical students at different time points of medical education and to identify predictors of functional coping.

Methods

A cross-sectional study was conducted among medical students (N = 497, 361 women and 136 men) before year one (n = 141), after year one (n = 135) and after year five (n = 220). Students answered the Brief Coping Orientation to Problems Experienced Inventory, the Work-Related Behaviour and Experience Patterns, the Perceived Medical School Stress Instrument and the Maslach Burnout Inventory. Multiple regression was used to examine factors associated with functional coping.

Results

Single factor ANOVA indicated a significant difference for functional coping between the time points (F (2, 494) = 9.52, p < .01), with fifth-year students scoring significantly higher than students before or after year one. There was a significant difference in dysfunctional coping (F (2, 494) = 12.37, p < .01), with students before year one and after year five scoring higher than those after year one. Efficacy (β = 0.15, t (213) = 4.66, p < .01), emotional distancing (β = 0.04, t (213) = 3.50, p < .01) and satisfaction with life (β = 0.06, t (213) = 4.87, p < .01) were positive predictors of functional coping.

Conclusions

Scores for both functional and dysfunctional coping vary during medical education. The reasons for low coping scores after year one require further explanation. These findings represent a starting point for investigations into how to promote functional coping during early medical education.

Psychometric properties of the effort-reward imbalance scale in Chinese version for university students

Objective

The main purpose of the study was to translate the Effort-Reward Imbalance Scale for University Students (ERIUS) and assess its psychometric properties in the Chinese cultural context.

Methods

We translated the original English version of the ERIUS into Chinese and undertook exploratory and confirmatory factor analysis using data collected from university students. The Stress Scale for College Students was selected as the criterion measure to examine the association between psychological stress and effort-reward imbalance. The validity and reliability of the translated version of the ERIUS were also assessed, and a sub-sample of participants (n = 120) completed the measure twice, with a two-week interval to assess test-retest reliability.

Result

Results of the exploratory factor analysis using data from 314 students showed that the Chinese version of the ERIUS had 14 items and 3 factors: effort, reward and overcommitment. Confirmatory factor analysis using data from 584 students showed that the Chinese version of the ERIUS had adequate structural validity (χ ² = 107.10, df = 32, RMSEA = 0.08, NFI = 0.90, CFI = 0.91, GFI = 0.90, PGFI = 0.62).

Conclusion

The Chinese version of the Effort-Reward Imbalance Scale for University Students has adequate psychometric properties in the Chinese cultural context and can be used as an effective tool to measure psychosocial stress of university students in China.

Comparison of the effect of in vitro and in vivo exposure on cadaveric anxiety among first year medical and nursing students

BACKGROUND

Human anatomy instruction is mostly focused on cadaver dissection and prosected specimen examination. Exposure to cadaver dissection can be a stressful experience that may cause a wide variety of symptoms among students of health sciences. To compare and evaluate the effect of in-vitro and in-vivo exposure on cadaveric anxiety, disgust propensity and sensitivity, and attitude toward death and dying among 1^st-year medical and nursing students.

MATERIALS AND METHODS

An open-label randomized trial (matched-control experimental design) was conducted among 127 1^st-year Medical and Nursing students from a selected Institute of National Importance, Bhopal, India during 2015. The participants were divided into an experimental and control group based on matched trait anxiety scores using the Trait Anxiety Inventory. Followed by preassessment, video demonstration with cadaver dissection (in vitro exposure) was then administered to the experimental group, while the control group had direct exposure to cadaver dissection (in vivo exposure).

RESULTS

The study showed that there was a statistically significant difference in state anxiety related to cadaver dissection in the experimental group (P = 0.01). However, video-demonstration of cadaver dissection did not have any effect on disgust propensity and sensitivity and attitude toward death and dying.

CONCLUSION

The findings provided evidence that video-demonstration of cadaver dissection reduced anxiety, although it did not have any effect on disgust and attitudes of death. The dissection hall experience may evoke feelings of anxiety and disgust that need to be addressed through advanced preparedness and coping strategies, especially among medical and nursing students.

Perceived stress and study-related behavior and experience patterns of medical students: a cross-sectional study

BACKGROUND

Distress and burnout are common in physicians. Both may already arise during medical training and persist throughout residency. An analysis of needs is necessary in order to develop target group specific curricular concepts at medical faculties. Aim of this study was to assess the perceived stress of medical students, to explore study-related behavior and experience patterns, and to investigate associated factors.

METHODS

We conducted a cross-sectional survey of medical students at the Hannover Medical School. The web-based questionnaire consisted of 74 items and included two standardized instruments: the "Work-related Behavior and Experience Patterns" (Arbeitsbezogene Verhaltens- und Erlebensmuster, AVEM) and the "Perceived Medical School Stress" scale (PMSS). Students were asked to state their self-perceived actual stress level on a scale from 0% (no stress at all) to 100% (maximum stress). We performed a classification and regression tree (CART) analysis to identify factors that can discriminate between the four different AVEM patterns.

RESULTS

Five hundred ninety-one medical students (female 75.8%, response rate: 34.0%) participated in the survey. The mean sum score of the PMSS was 37.2 (SD 8.3; median score 37, min.-max. = 18-65). Overall, 68.5% of the students showed a risk pattern (risk pattern A "overexertion": 38.9%; risk pattern B "burnout": 29.6%). Pattern G "healthy" was shown in 8.3% and pattern S "protection" in 23.1% of the students. Multilevel analysis revealed that the self-perceived stress level and the PMSS sum score were the most important predictors for the AVEM pattern assignment. Furthermore, academic year, gender, and financial dependency were relevant influencing factors: students in higher academic years with no financial support had a higher probability to be in risk pattern B whereas male students in the first academic year tended to be in pattern G.

CONCLUSIONS

The PMSS sum score could objectify medical students' high self-perceived stress level. The majority of participating students showed a risky study-related behavior and experience pattern. Medical faculties should be aware of the still existing and relevant problem of stress and burnout among medical students. Our results lay the groundwork for an evaluation and further development of medical curricula at the own faculty.

Impacts of a gross anatomy laboratory course on medical students' emotional reactions in Taiwan: the role of high-level emotions

BACKGROUND

Gross anatomy laboratory course at medical school is usually an important learning subject for medical students; however, seeing a cadaver often makes them feel uncomfortable. According to the broaden-and-build theory, positive emotions broaden our inventory of thoughts and actions, and build physical, mental, and social resources. Research on positive psychology found that through direct thanks and positive reframing, people who feel gratitude show fewer depressive symptoms. The present study tried to reduce students' negative emotions towards cadavers by sequential activities, such as family interviews and an initiation ceremony, which induced gratitude and other positive emotions.

METHODS

The Emotional Reactions Towards Cadavers Scale (ERTCS) was used to evaluate medical students' emotional reactions after they see a cadaver. Third year medical students (n = 105) at Taipei Medical University in northern Taiwan completed ERTCS on three occasions within a single semester during academic year 2016. Repeated-measures ANOVA and hierarchical regression analyses were then conducted to identify any changes in the emotional reactions of these students.

RESULTS

The ERTCS showed satisfactory internal consistency and a three-factor structure, i.e., negative emotions, high-level emotions, and excited emotions. High-level emotions were the highest, and negative emotions were the lowest among the three in our sample. Three-wave data showed that participants' high-level emotions increased, negative emotions decreased, and the former simultaneously predicted the latter after controlling for the influence of gender, religious beliefs, experience of the death of a family member or friend, and burnout level.

CONCLUSIONS

While past research usually focused on coping strategies to reduce medical students' negative emotions, our study supported the broaden-and-build theory, which emphasizes positive emotions, and demonstrated that elevating medical students' gratitude to 'silent mentors' is an effective way. It is suggested that combining dissection courses with medical humanities can help students successfully handle negative emotions during a gross anatomy laboratory course.

Exploring Nursing Students' Experiences in the Anatomy Laboratory to Optimize Their Learning

BACKGROUND

In medicine, dissecting human cadavers is vital for learning anatomy, developing professional skills, and fostering a relationship with the body. This opportunity has received little pedagogical attention in nursing. The purpose of this study was to understand the experiences of nursing students in the human anatomy laboratory to inform strategies that may be implemented to optimize learning.

METHOD

A qualitative descriptive study was conducted to analyze reflective assignments completed by undergraduate and graduate nursing students following participation in a required session in the human cadaver anatomy laboratory.

RESULTS

Overall, 168 assignments were included in the analysis. Three themes were identified: Coping With the Initial Shock, Reflecting on the Salience of Death and Dying, and Acknowledging Impacts on Future Practice.

CONCLUSION

The students' reflections support the integration of a human anatomy laboratory session into the nursing curriculum and inform strategies to foster learning and development. [J Nurs Educ. 2021;60(4):221-224.].

Prevalence of depression and anxiety and correlations between depression, anxiety, family functioning, social support and coping styles among Chinese medical students

Background

Medical students experience depression and anxiety at a higher rate than the general population or students from other specialties. While there is a growing literature on the high prevalence of depression and anxiety symptoms and about potential risk factors to the prevalence of depression and anxiety symptoms among medical students, there is a paucity of evidence focused on the prevalence of depression and anxiety symptoms and associations with family function, social support and coping styles in Chinese vocational medicine students. This study aims to investigate the prevalence of depression and anxiety symptoms among Chinese medical students and assess the correlation between depression/anxiety symptoms and family function, social support and coping styles.

Methods

A sample of 2057 medical students from Chongqing Medical and Pharmaceutical College in China was investigated with a self-report questionnaire, which included demographic information, Zung self-rating depression scale, Zung Self-Rating Anxiety Scale, Family APGAR Index, Social Support Rating Scale and Trait Coping Style Questionnaire.

Results

The prevalence of depression and anxiety symptoms among the medical students was 57.5 and 30.8%, respectively. Older students(≥20 years) experienced higher levels of depression and anxiety. More depression and anxiety symptoms were exhibited among students with big financial burden, big study-induced stress and poor sleep quality. Students with large employment pressure showed more anxiety symptoms. Students who live alone or had bad relationship with their lovers or classmates or friends showed higher depression and anxiety scores. Depression and anxiety symptoms had highly significant correlations with family functioning, social support and coping style.

Conclusions

Academic staffs should take measures to reduce depression and anxiety among medical students and to provide educational counseling and psychological support for students to cope with these problems.

Cadaver Dissection Is Obsolete in Medical Training! A Misinterpreted Notion

Cadaver dissection (CD) is considered a tool for studying the structural details of the human body. Lately, conflicting opinions regarding the utility of this modality in medical training have been published in medical literature. This review of the literature examines the status of anatomy teaching with CD in traditional, modern, and postgraduate medical training across the world. Literature published in the En-glish language on topics related to CD in the past 3 decades was scrutinized using different search engines. About 200 full texts were reviewed. We describe how medical schools have continued to include CD in anatomy teaching in the traditional or modified form. Medical schools that stopped or decreased CD have learnt from their experiences, and have restarted it in modified forms by integrating it vertically with medical training. In addition, CD activities have increased in postgraduate anatomy courses, surgery training, and voluntary/optional CD programs. CD, when integrated vertically, still has a part to play in medical training in modified ways. This overview may help curriculum designers to place CD in medical curricula and training programs in a justified manner.

Effects of a "silent mentor" initiation ceremony and dissection on medical students' humanity and learning

OBJECTIVES

Many medical schools in Taiwan have adopted a dignified "silent mentor" initiation ceremony to strengthen student's medical humanity and increase their learning attitudes. This ceremony consists of introductions of the body donor's conduct and deeds, wreath-laying, and a tea party. However, few empirical studies have examined the influences of the ceremony and dissection on medical humanity. This study explored if the initiation ceremony and the course can help students care more about others, develop more positive attitudes toward death, improve learning effectiveness in the course, and decrease negative emotions the first time they see a cadaver.

METHODS

The Attitudes Towards Death and Love and Care subscales of the life attitude inventory, Learning Effectiveness of Gross Anatomy Laboratory Scale (LEGALS), and Emotional Reactions Towards Cadavers Scale were adopted to examine differences before (T1) and after (T2) medical students attended an initiation ceremony at a university in northern Taiwan. Whether these effects lasted to the end of the semester (T3) was also tested.

RESULTS

After the ceremony, students' attitudes towards death increased, negative emotions towards cadavers decreased, but love and care and the LEGALS did not significantly change. Data from T3 showed a similar pattern, but high-level emotions (e.g., being respected, cherished, and grateful) and the LEGALS were significantly higher than those at T1.

DISCUSSION

The initiation ceremony, which showed a body donor's deeds and attitudes toward life and death when they were alive, could help medical students gain more mature attitudes towards death and decreased negative emotions. Learning between T2 and T3 might have caused significant changes in high-level emotions and the LEGALS at T3. Arranging reflective writing with guided discussion by a teacher before and after the ceremony is highly recommended.

Peer-Led, Postanatomy Reflection Exercise in Dissection Teams: Curriculum and Training Materials

INTRODUCTION

The importance of emphasizing empathy, reflection, and professionalism during anatomy dissection has been well established. This small-group curriculum was developed to fulfill a need for structured reflection at the end of anatomy.

METHODS

In this 45-minute reflection session, each dissection team of first-year medical students in anatomy is led by one or two peer facilitators recruited from the second-year medical student class. The session is designed to include a time for sharing of personal reflections, a clinical observation activity about the cadaver's cause of death, and an appreciative inquiry approach to the dissection team experience. In addition to the reflection session curriculum, materials also include a 1-hour presession training module, containing a small-group facilitator skill-building and role-play and a 30-minute postsession debrief for peer facilitators.

RESULTS

We found that the majority of anatomy students felt that the end-of-course reflection was a meaningful way to conclude the course and that the session had a positive impact on their relationship with their dissection team. Fifteen peer facilitators participated in focus groups, and common themes included the value of giving back, making meaning of past experiences, countering burnout by recognizing one's own growth, and continued learning through peer teaching.

DISCUSSION

This anatomy reflection curriculum has been incorporated into our 7-week anatomy course and has been well received by both anatomy students and peer facilitators. We believe that peer-led small-group reflection sessions after intensive experiences in medical school can promote personal and professional growth among both junior and senior medical students.

Human Dissection in Medical Education: More than Just Anatomy

The dissection course is an essential component of the medical curriculum. Nonetheless, the time expenditure and intensity of supervising the students in this course has been diminishing since the 1970s. That endangers not only the transmission of fundamental knowledge of anatomy. It also concerns key concepts such as establishing values, the concept of humans, and physician competencies, because medical education must be seen not merely as fact-directed instruction but instead should be connected with a mission for professional acculturation.

Study on personality dimension negative emotionality affecting academic achievement among Malaysian medical students studying in Malaysia and overseas

Personality dimension negative emotionality is known to be associated with academic achievement. The present study focuses on the influence of negative emotionality (neuroticism) on the medical students' academic achievements. The main objective of this study was to ascertain the negative emotionality scores among the first year Malaysian medical students studying in Malaysia and India, further to find out the association between negative emotionality and their academic achievements. The current study sample includes 60 first year Malaysian medical students from Universiti Sultan Zainal Abidin, Malaysia, and USM-KLE IMP, Belgaum, India. They were selected by convenient sampling technique. The Medico-Psychological questionnaire was used to find out the negative emotionality scores among the students and these scores were compared with academic scores. The data were analyzed using SPSS- 20. Thus, the study result goes with the prediction that there is a significant correlation between academic achievement and negative emotionality. We concluded that negative emotionality has a negative impact on medical student's academic achievement regardless of the fact whether they study in their own country or overseas.

Stressors and starting points for health-promoting interventions in medical school from the students' perspective: a qualitative study

INTRODUCTION

Medical education is considered very challenging and connected with high levels of psychosocial stress for students. The aim of this study was to identify stressors and possible starting points for health-promoting interventions from the perspective of the students themselves.

METHODS

We conducted two focus groups with medical students from pre-clinical and clinical semesters. We analyzed the data using content analysis following Mayring's approach.

RESULTS

The stressors in the pre-clinical stage of medical education were more diverse and perceived as more intense than those in the clinical stage. They comprised contextual factors and individual behaviour. Participants mentioned the weekly examinations as a specific stressor. The existing absence regulations gave the participants the impression that they should not be absent through illness at any point during the course, and this idea further promoted presenteeism. Peer groups and mentoring programmes were perceived as helpful.

CONCLUSIONS

Stressors and starting points for health-promoting interventions are closely related to the medical curriculum and its organization. As such, the curriculum itself-in addition to programmes aimed at improving stress management-should primarily stand at the centre of activities for enhancing students' health.

The effects of dissection-room experiences and related coping strategies among Hungarian medical students

BACKGROUND

Students get their first experiences of dissecting human cadavers in the practical classes of anatomy and pathology courses, core components of medical education. These experiences form an important part of the process of becoming a doctor, but bring with them a special set of problems.

METHODS

Quantitative, national survey (n = 733) among medical students, measured reactions to dissection experiences and used a new measuring instrument to determine the possible factors of coping.

RESULTS

Fifty per cent of students stated that the dissection experience does not affect them. Negative effects were significantly more frequently reported by women and students in clinical training (years 3,4,5,6). The predominant factor in the various coping strategies for dissection practicals is cognitive coping (rationalisation, intellectualisation). Physical and emotional coping strategies followed, with similar mean scores. Marked gender differences also showed up in the application of coping strategies: there was a clear dominance of emotional-based coping among women. Among female students, there was a characteristic decrease in the physical repulsion factor in reactions to dissection in the later stages of study.

CONCLUSIONS

The experience of dissection had an emotional impact on about half of the students. In general, students considered these experiences to be an important part of becoming a doctor. Our study found that students chiefly employed cognitive coping strategies to deal with their experiences. Dissection-room sessions are important for learning emotional as well as technical skills. Successful coping is achieved not by repressing emotions but by accepting and understanding the negative emotions caused by the experience and developing effective strategies to deal with them. Medical training could make better use of the learning potential of these experiences.

Psychosocial aspects of donation and the dissection course: An extra-curricular program with the objective of assisting students confront issues surrounding gross anatomy lab

Background and aim: The dissection course is an essential part of preclinical medical education. At the Medical Faculty of Duesseldorf, an education concept has been developed with the aim, to reflect with students their experiences and to support them in dealing with the donor and preparation. The aim of this paper is to present the concept.

Method: The education concept had a peer group approach. It comprised a lecture, a small group seminar and an online diary as core element. Finally, the concept was evaluated.

Results: Approximately one sixth of students made use of the online diary. Selected entries are presented here. Also, one sixth of students took part in the evaluation. They rated the activity as helpful to prepare for the dissection course.

Discussion: The education concept could be a corner stone of a longitudinal training to promote the adequate encounter with topics such as dying and death.

Measurement of specific medical school stress: translation of the "Perceived Medical School Stress Instrument" to the German language

Objective: Medical students encounter specific stressors during their studies. As a result, they develop anxiety, depression and burnout symptoms more frequently than their similarly aged, but employed counterparts. In 1984, Vitaliano et al. published a 13-item instrument for the measurement of stress specific to medical school: the “Perceived Medical School Stress Instrument“ (PMSS). Since then, it has been widely applied and validated in English-speaking countries. No German version of the PMSS exists to date. Thus, our aim was to translate the instrument into the German language in order to be able to measure medical school stress in German-speaking countries.

Method: The items of the PMSS were translated into German by three separate researchers. The resulting translations were compared and combined with each other to establish a first German version of each item in the PMSS. These items were then translated back into English by two native English speakers to validate the correct primary translation. Based on a revised German version, a cognitive debriefing with 19 German medical students and a theoretical testing on 169 German medical students, the final German translations for each of the 13 items were determined.

Results: The PMSS was easily translated into German and there was a high congruency between the primary translations into German and the secondary translations back into English. Incongruities between the translations were solved quickly. The assessment of the German equivalent of the PMSS showed good results regarding its reliability (Cronbach’s Alpha 0.81).

Conclusion: A German version of the PMSS is now available for measuring the medical school related stress in German-speaking countries.