Understanding students' motivations for participating in a mindfulness course: a qualitative analysis of medical students' views

OBJECTIVES

Improving medical students' wellbeing and empowerment through curricular activities is a topic of interest worldwide. Mindfulness-based interventions (MBIs) are increasingly implemented in medical education often as part of elective courses. To better understand training outcomes and adjust curriculum to students' needs, we will explore why will medical students participate in meditation-based education?

METHODS

We analyzed 29 transcripts from the first session of an 8-week MBSR program offered to medical students in French. Transcripts were coded and analyzed using a qualitative content thematic analysis and the constant comparison method.

RESULTS

Analyses resulted in three themes describing students' motivation: (1) Medical education and the physician's role, i.e. improving interpersonal skills, acquiring skills oriented toward a more integrative medicine, being more productive in a highly competitive context. (2) Caring for my health i.e. aiming at stress reduction, emotion regulation, and improving self-compassion. (3) A quest for meaning, i.e. optimizing meaning of care, and meaning of life.

CONCLUSION

The results highlight the congruence between the perceived motivations and the evidence on the effect of mindfulness on self-care, the development of humanistic medical skills, and the meaning of care. Some findings raise the issue of the limits of using mindfulness to enhance one's productivity. Notably, participants articulated the need for self-care as in mindfulness training, with the ability to care for others.

Consistent or inconsistent? The effects of inducing cognitive dissonance vs. cognitive consonance on the intention to engage in pro-environmental behaviors

How do individuals rationalize the cognitive dissonance between their environmental awareness and the maintenance of environmentally unfriendly behaviors? The main goal is to explore the rationalization strategies used by individuals in order to maintain their current behaviors. The secondary goal is to understand if it is possible to induce cognitive consonance, and how this influences intention to change. We present a study (N = 222) with three experimental conditions: inconsistency, control, and consistency. The method to induce inconsistency and consistency was inspired by the paradigm of induced hypocrisy. Results demonstrated that induced inconsistency elicits two main barriers in participants: considering the change as unnecessary, and perceiving to lack knowledge about how to change. Induced consistency elicits tokenism, resulting in a licensing effect. However, behavioral intentions did not differ among experimental groups. Results are discussed considering methodological limitations and possible intervening variable.

Developing Children's Socio-Emotional Competencies Through Drama Pedagogy Training: An Experimental Study on Theory of Mind and Collaborative Behavior

Drama pedagogy training (DPT) is a drama-based-pedagogy focused on socio-emotional-learning (SEL) development, over academic or artistic. This study aims to see if DPT promotes theory of mind (ToM) and collaborative behavior in 126 French children aged 9-10 years old, randomly assigned to an experimental group (DPT), either a control group for 6 weeks. Post-tests showed large effects of training on ToM, F(1, 124) = 24.36, p < .001, η² =.16, and collaborative behavior, F(1, 124) = 29.8, p < .001, η² = .19. T-test showed significant differences on ToM (t = -4.94, p < .001) and collaborative behavior (t = -5.46, p < .001), higher for DPT. Effects of type of school and grade are discussed. Results confirm the hypotheses.

Fostering Children and Adolescents' Creative Thinking in Education. Theoretical Model of Drama Pedagogy Training

Drama Pedagogy Training (DPT), as other drama-based pedagogies, has been related to several outcomes, including creativity enhancement. This enhancement is commonly proven through the measurement of different creative processes. In our review we systematize characteristics, activities and techniques of DPT that are assumed to be related to creativity in order to have a more comprehensive framework to identify the specific DPT elements that are involved in the enhancement of some of the creative processes of children and adolescents. To this end, we identified five creative processes in experimental studies using DPT: divergent thinking, fantasy and imagination, associative thinking, symbolization, and problem solving. These processes were cross referenced with DPT characteristics, activities, and techniques that were argued to be related to creativity enhancement. Our review will propose a model with two main categories and six elements as follows: (1) technical drama phases which emphasizes the role of narrative and embodiment through (a) corporal and vocal training and (b) main drama techniques (e.g., storytelling and improvisation and role-play), and (2) psycho-pedagogical framework which emphasizes the role of a dialogic space through (c) playfulness and a (d) collaborative, safe space. We also identified (e) feedback as an important element of DPT which belongs to both drama technical phases and psycho-pedagogical framework categories. Along with the model, we explain the creative outcomes associated to each of these elements as a means to attire the attention to drama-based pedagogies for the development of creativity in the educational setting.

Confirmation of a Two-Factor Solution to the Questionnaire of Cognitive and Affective Empathy in a French Population of Patients With Schizophrenia Spectrum Disorders

The Questionnaire of Cognitive and Affective Empathy (QCAE) is a tool for self-assessing the cognitive and emotional components of empathy. A study showed that a two-factor model fits the data of patients with schizophrenia, whereas other reports on healthy subjects have suggested a five-factor decomposition. We aimed to replicate the model of Horan et al. in a French population with schizophrenia spectrum disorders (i.e., schizophrenia and schizoaffective disorders) participating in the EVACO Study (NCT02901015). In total, 133 patients were assessed with the QCAE, the Positive and Negative Symptom Scale (PANSS), the Personal and Social Performance Scale (PSP), and the Self rating Quality of Life Scale (S-QoL). The two-factor model demonstrated an adequate fit with the data, comparable to that reported by Horan et al. Males scored higher on the Affective subscore than females. After correction for multiple tests, psychopathology (PANSS) and functioning (PSP) did not correlate significantly with the QCAE subscores. However, quality of life (S-QoL) correlated positively with the Emotional Contagion subscore. Thus, the variability of empathetic disposition in schizophrenia may be considered through the cognitive versus affective dichotomy and properly investigated with the QCAE. The results support further investigation of the relationship between QCAE scores and subjective outcome measurements, such as quality of life, and emphasize the importance of cross-cultural comparisons.

What Are the Stages of the Creative Process? What Visual Art Students Are Saying

Within the literature on creativity in the arts, some authors have focused on the description of the artistic process (Patrick, 1937; Getzels and Csikszentmihalyi, 1976; Mace and Ward, 2002; Yokochi and Okada, 2005) whereas others have focused on the creative process (Wallas, 1926; Osborn, 1953/1963; Runco and Dow, 1999; Howard et al., 2008). These two types of processes may be, however, somewhat distinct from each other because the creative process is not always dedicated to artistic creation, and productive work in the arts may not always involve creativity, in terms of specifically original thinking. Our goal is to identify the specific nature of the artistic creative process, to determine what are the basic stages of this kind of process. This description can then be integrated in a Creative process Report Diary (CRD; Botella et al., 2017) which allows self-observations in situ when participants are creating.

Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality

Several disciplines have investigated the interconnected empathic abilities behind the proverb "to walk a mile in someone else's shoes" to determine how the presence, and absence, of empathy-related phenomena affect prosocial behavior and intergroup relations. Empathy enables us to learn from others' pain and to know when to offer support. Similarly, virtual reality (VR) appears to allow individuals to step into someone else's shoes, through a perceptual illusion called embodiment, or the body ownership illusion. Considering these perspectives, we propose a theoretical analysis of different mechanisms of empathic practices in order to define a possible framework for the design of empathic training in VR. This is not intended to be an extensive review of all types of practices, but an exploration of empathy and empathy-related phenomena. Empathy-related training practices are analyzed and categorized. We also identify different variables used by pioneer studies in VR to promote empathy-related responses. Finally, we propose strategies for using embodied VR technology to train specific empathy-related abilities.

How Efficient Are Emotional Intelligence Trainings: A Meta-Analysis

This multilevel meta-analysis examines whether emotional intelligence (EI) can be enhanced through training and identifies training effects’ determinants. We identified 24 studies containing 28 samples aiming at increasing individual-level EI among healthy adults. The results revealed a significant moderate standardized mean change between pre- and post-measurement for the main effect of EI training, and a stable pre- to follow-up effect. Additionally, the type of EI model, dimensions of the four branch model, length, and type of publication turned out to be significant moderators. The results suggest that EI trainings should be considered effective interventions.

Is the Questionnaire of Cognitive and Affective Empathy measuring two or five dimensions? Evidence in a French sample

Although many instruments measure empathy, most of them focus on specific facets (e.g., Spreng et al., 2009) or specific contexts (e.g. Wang et al., 2003) of empathy. For this reason, the Questionnaire of Cognitive and Affective Empathy (QCAE; Reniers et al., 2011) was recently built to grasp the general construct of empathy through its Affective-Cognitive duality, although not providing clear-cut results about the bidimensionality of the scale. In this study, Confirmatory Factor Analyses were conducted on the responses of 418 adults on the French QCAE (backtranslated for this study). A total of 8 models were tested - including the models of the original investigation. The 5-correlated factors model had the best fit, and the pattern of correlations between the factors did not support the Cognitive-Affective distinction. The QCAE is discussed as showing signs of psychometrical robustness, but also as a tool that is more 5-dimensional than bidimensional.

Monitoring stress among internal medicine residents: an experience-driven, practical and short measure

Residents experience severely high levels of stress, depression and burnout, leading to perceived medical errors, as well as to symptoms of impairment, such as chronic anger, cognitive impairment, suicidal behavior and substance abuse. Because research has not yet provided a psychometrically robust population-specific tool to measure the level of stress of medicine residents, we aimed at building and validating such a measure. Using an inductive scale development approach, a short, pragmatic measure was built, based on the interviews of 17 medicine residents. The Internal Medicine Residency Stress Scale (IMRSS) was then administered in a sample of 259 internal medicine residents (199 females, 60 males, M_Age = 25.6) along with the Hospital Anxiety and Depression Scale, Maslach Burnout Inventory, Satisfaction With Life Scale and Ways of Coping Checklist. The IMRSS showed satisfactory internal reliability (Cronbach's α = .86), adequate structural validity - studied through Confirmatory Factor Analysis (χ²/df = 2.51, CFI = .94; SRMR = .037, RMSEA = .076) - and good criterion validity - the IMRSS was notably strongly correlated with emotional exhaustion (r = .64; p < .001) and anxiety (r = .57; p < .001). Because of its short length and robust psychometric qualities, the use of the IMRSS is recommended to quickly and frequently assess and monitor stress among internal medicine residents.

Understanding The Mediating Role of Quality of Work Life on the Relationship between Emotional Intelligence and Organizational Citizenship Behaviors

Organizational citizenship behaviors are not directly rewarded by organizations. However, they seem to contribute to excellent performance at work. The aim of this study is to test quality of working life's (QoWL) mediating role in the relationship between emotional intelligence (EI) and organizational citizenship behaviors (OCB). 203 French adults working regularly in teams completed validated self-report measures corresponding to each construct. The collected data showed that in the studied sample, a high quality of working life was associated with Sportsmanship behaviors. However, mediation was not observed for the other OCB subscales: Altruism, Helping, or Civic virtues. These behaviors tend to occur in individuals with high emotional intelligence scores, unrelated to their quality of working life. Theoretical background, practical implications, and limitations of the study are discussed.

The Effects of Emotional Competences Training among Unemployed Adults: A Longitudinal Study

BACKGROUND

The present study aimed at analyzing whether training in emotional competences (EC) would increase the level of perceived EC among unemployed adults, whether the unemployment duration would moderate the effects of the training and whether the changes in EC would predict changes in the levels of perceived stress, somatic complaints, mental health, and mood states.

METHODS

Seventy-five participants were randomly allocated to an EC training program, or a control group. Following a controlled experimental design, the participants completed all the measures prior to the intervention (T1), one month later (T2) and six months after the first data collection (T3).

RESULTS

The results showed that change in EC after the training depended on the duration of unemployment. The difference between the experimental and control groups in EC after the training was significant when the participants had been unemployed for less time. In addition, the results indicated that changes in EC were found to be significant predictors of changes in perceived stress, mental health, somatic complaints, and vigor and confusion (mood dimensions) six months after the intervention.

CONCLUSION

The data suggest that unemployment duration plays a crucial role in determining the range and intensity of intervention effects.

Relationship between optimism and quality of life in patients with two chronic rheumatic diseases: axial spondyloarthritis and chronic low back pain: a cross sectional study of 288 patients

BACKGROUND

Axial Spondyloarthritis (AxSpA) and chronic low back pain are rheumatic diseases that impact patients' health-related quality of life (HRQoL). In other chronic conditions, HRQoL was positively associated with dispositional optimism, a personality trait. The objective was to explore the relationship between optimism and HRQoL in these two diseases.

METHOD

A cross-sectional study was performed in 2 tertiary care hospitals and 2 private practices in France. Patients had definite AxSpA or chronic low back pain according to the rheumatologist. A generic HRQoL questionnaire (Short Form, SF-12) with physical and mental composite scores (PCS and MCS respectively) and an optimism questionnaire (the Life Orientation Test-revised, LOT-R) were collected. Analyses included non-parametric correlations and multiple regression analyses to study the effect of optimism on PCS and MCS.

RESULTS

In all, 288 (199 AxSpA and 89 low back pain) patients were included: mean age, 47.3 ± 11.9 years, 48.6 % were males. Pain levels (0-10) were 4.5 ± 2.4 and 4.3 ± 2.4 in AxSpA and LOW BACK PAIN patients, respectively. HRQoL was similarly altered in both diseases, for both physical and mental composite scores (mean PCS: 43.7 ± 8.2 vs. 41.9 ± 7.1; mean

MCS

45.9 ± 7.8 vs. 46.7 ± 8.1 for AxSpA and low back pain respectively). Optimism was moderate and similar in both populations. Optimism was positively correlated to MCS in both diseases (rho = 0.54 and 0.58, respectively, both p <0.01) and these relations persisted in multivariate analyses (beta = 1.03 and 1.40, both p <0.0001).

CONCLUSIONS

Optimism was similar in these 2 chronic diseases and was an explanatory factor of the mental component of HRQoL, but not physical HRQoL. Physical HRQoL may reflect more the disease process than character traits.

Quality of life and illness perception in primary biliary cirrhosis: a controlled cross-sectional study

OBJECTIVE

The aim of this study was to understand better the quality of life (QOL) and illness perception in women with primary biliary cirrhosis (PBC) through a comparison with women having diabetes.

METHODS

One hundred and ninety-four women took part in this study: 130 with PBC, 64 with type 2 diabetes. They were administered the SF-12 to measure QOL and the Brief Illness Perception Questionnaire to assess representations of their illness. Analysis of covariance with bootstrapping was used to compare QOL and illness perception scores by controlling age and mean disease duration.

RESULTS

Physical QOL was significantly worse for women with PBC than for women with diabetes. Women with PBC felt their disease would last longer and reported more symptoms and concerns related to their disease than women with diabetes. Significant differences were also observed for causes: women with PBC mainly reported autoimmune, emotional, unknown/unlucky and medical causes whereas women with diabetes reported mostly lifestyle and hereditary causes. Marginally significant differences were observed regarding consequences on daily life, feeling of control over the disease and emotional responses, which were shown to be worse in PBC. Mental QOL, treatment control and overall understanding of the disease was similar in both groups.

CONCLUSIONS

This study shows that women with PBC have a worse QOL and somewhat different illness perception than women with diabetes. Further research could help understand PBC specificities better in order to improve patient care, especially if factors such as fatigue or rarity of the disease explain these results.

To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice

Background

General practice is stressful and burnout is common among family physicians. A growing body of evidence suggests that the way physicians relate to their patients could be linked to burnout. The goal of this study was to examine how patterns of empathy explained physicians’ burnout.

Methods

We surveyed 294 French general practitioners (response rate 39%), measured burnout, empathic concern (EC) and perspective taking (PT) using self-reported questionnaires, and modeled burnout levels and frequencies with EC, PT and their interaction in linear and logistic regression analyses.

Results

Multivariate linear models for burnout prediction were associated with lower PT (β = −0.21, p < 0.001) and lower EC (β = −0.17, p < 0.05). Interestingly, the interaction (EC x PT) also predicted burnout levels (β = 0.11, p < 0.05). The investigation of interactions revealed that high scores on PT predicted lower levels of burnout independent from EC (odd ratios (OR) 0.37; 95% confidence interval (95% CI) 0.21–0.65 p < 0.001), and high scores on both EC and PT were protective against burnout: OR 0.31; 95% CI 0.15–0.63, p < 0.001).

Conclusions

Deficits in PT alone might be a risk factor for burnout, whereas higher PT and EC might be protective. Educators should take into account how the various components of empathy are potentially associated with emotional outcomes in physicians.

Creativity as action: findings from five creative domains

The present paper outlines an action theory of creativity and substantiates this approach by investigating creative expression in five different domains. We propose an action framework for the analysis of creative acts built on the assumption that creativity is a relational, inter-subjective phenomenon. This framework, drawing extensively from the work of Dewey (1934) on art as experience, is used to derive a coding frame for the analysis of interview material. The article reports findings from the analysis of 60 interviews with recognized French creators in five creative domains: art, design, science, scriptwriting, and music. Results point to complex models of action and inter-action specific for each domain and also to interesting patterns of similarity and differences between domains. These findings highlight the fact that creative action takes place not "inside" individual creators but "in between" actors and their environment. Implications for the field of educational psychology are discussed.

Empathic concern and professional characteristics associated with clinical empathy in French general practitioners

OBJECTIVE

Clinical empathy, i.e. the ability of physicians to adopt patient perspective, is an essential component of care, which depends in part on empathic concern, i.e. compassionate emotions felt for others. However, too much empathic concern can be challenging for physicians. Aim of this study was to examine physician practice characteristics that could explain clinical empathy beyond empathic concern. We were also interested in testing whether professional reflective activities, such as Balint group attendance or clinical supervision, might make clinical empathy less dependent on empathic concern.

METHODS

A total of 295 French general practitioners (response rate of 37%) completed self-reported questionnaires on empathic concern and clinical empathy, using the Toronto empathy questionnaire (TEQ) and the Jefferson scale of physician empathy (JSPE), respectively. We also recorded information on their professional practice: professional experience, duration of consultations, and participation in Balint groups or being a clinical supervisor. Hierarchical regression analyses were carried out with clinical empathy as dependent variable.

RESULTS

Empathic concern was an important component of clinical empathy variance. The physician practice characteristics 'consultation length' and 'being a Balint attendee or a supervisor,' but not 'clinical experience' made a significant and unique contribution to clinical empathy beyond that of empathic concern. Participating to one reflective activity (either Balint group attendance or clinical supervision) made clinical empathy less dependent on empathic concern.

CONCLUSION

Working conditions such as having enough consultation time and having the opportunity to attend a professional reflective activity support the maintenance of clinical empathy without the burden of too much empathic concern.

The changing face of Parkinson's disease-associated psychosis: a cross-sectional study based on the new NINDS-NIMH criteria

New criteria for Parkinson's disease-associated psychosis (PDAP) were recently proposed by a NINDS-NIMH working group. We assessed 116 consecutive unselected outpatients with PD for the existence of psychotic symptoms during the previous month, using a structured questionnaire covering the whole spectrum of PDAP symptoms. Hallucinations occurred in 42% of the patients (visual: 16%; nonvisual: 35%), delusions in 4%, and minor symptoms in 45% (sense of presence, visual illusions, or passage hallucinations). The prevalence of PDAP was 43% when the usual definition was used (hallucinations and/or delusions) and 60% when the NINDS-NIHM criteria were used. Correlations between PDAP and patient characteristics varied with the definition of PDAP. These findings suggest that the epidemiology of PDAP should be re-evaluated with the new criteria. Minor symptoms and nonvisual hallucinations are an important part of the PDAP spectrum, which has commonly been restricted to visual hallucinations and delusions.

Emotion-Related Traits Moderate the Impact of Emotional State on Creative Performances

The present study shows that the impact of emotional states on creativity depends on individual emotional characteristics as well as the type of task used. The results found during the last 30 years diverge concerning relationships between emotion and creative cognition. For this reason, we conducted a study to explore whether the impact of emotional states on creative potential is moderated by individuals’ emotional traits. Using a multivariate approach, we measured (1) emotional valence and arousal level of participants after an emotional induction, (2) emotional traits (e.g., alexithymia, emotional expressivity, affective intensity, emotional idiosyncrasy), and (3) quantity, originality, and valence of generated ideas in two distinct divergent thinking tasks. Participants were 107 undergraduate university students. Regression analyses confirm our hypothesis showing that the impact of emotional states on creative performance is not uniform, but depends on participants’ emotional state and emotion-related traits. For example, we observed that the more individuals had difficulty with emotional information and the higher their level of arousal, the less they generated pleasant ideas. Several processes such as arousal regulation may explain the observed results.

Functional results and quality of life for patients with very low rectal cancer undergoing coloanal anastomosis or perineal colostomy with colonic muscular graft

BACKGROUND

The aim of this study was to compare functional results and quality of life (QoL) of two salvage techniques: coloanal anastomosis (CAA) or perineal reconstruction after abdominoperineal resection for very low rectal cancer.

METHODS

Between 1991 and 2001, 50 patients were operated for a very low rectal adenocarcinoma and analyzed after a follow-up greater than one year and because there was no relapse or no treatment, they were included in the analysis. Thirty-eight patients had a CAA, including: straight anastomosis (n=23), J pouch (n=10), coloplasty (n=2) and intersphincteric resection (n=3). Twelve patients underwent a PC.

RESULTS

Vaizey's incontinence score was equivalent for the two groups: CAA 12 (0-22) versus PC 11 (8-13). The only differences were more frequent fractioned stools for the CAA group and increased pad soiling for the PC group. Overall QoL scores (QLQ C-30) were equivalent for CAA and PC.

CONCLUSIONS

For very low rectal tumors, the choice of surgical technique must be based on oncologic rather than future functional or QoL criteria, because both approaches seem to provide similar results.

Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients' characteristics

PURPOSE

This study was designed to compare the impact of a permanent colostomy and sociodemographic characteristics on the quality of life of patients operated on for low rectal cancer.

METHODS

A cross-sectional study was performed by use of the European Organization for Research and Treatment of Cancer QLQ-C30 and CR-38 questionnaires. Patients came to the hospital to fill out the self-administered questionnaire or were sent the questionnaire by mail, followed by a live or telephone interview. All patients had undergone one of four operations: low anterior resection with colorectal or coloanal anastomosis (non-stoma group), or abdominoperineal resection with pseudocontinent perineal colostomy (nonstoma group) or left lower quadrant colostomy (stoma group).

RESULTS

A total of 132 patients were included for analysis and there were no missing data. For the majority of quality of life scores (26/29), there was no significant difference between stoma and nonstoma patients. However, stoma patients complained of diminished body image (P = 0.0022), and this was especially true for married (P = 0.0073) and less educated (P = 0.0014) patients at subgroup analysis. Stoma patients experienced greater financial worries (P = 0.0029), whereas nonstoma patients had greater gastrointestinal concerns (P = 0.0098).

CONCLUSIONS

Although most quality of life scores between stoma and nonstoma patients were similar, significant differences regarding body image, finance, and gastrointestinal symptoms, especially for married and less educated patients, were noticed. These factors should be taken into account, along with oncologic criteria, to better tailor treatments to patients.