Screening for burn-out in Australian medical students undertaking a rural clinical placement

ObjectiveTo investigate Australian medical student burn-out during rural clinical placement. Second, to examine the association between perceived burn-out and rural career intent at the time of finishing their rural placement.Design, settings and participantsThe 2016 Federation of Rural Australian Medical Educators evaluation survey is a cross-sectional study of medical students from 17 Australian universities. Specifically, those medical students who completed a full academic year or more at a Rural Clinical School (RCS). Responses from 638 medical students from regional Australia were analysed in the study of all eligible 756 medical students (response rate 84.3%).Primary and secondary outcome measuresThe primary objective was to determine self-reported burn-out (emotional exhaustion) in rural placements for medical students. Secondary outcome measures were designed to explore interactions with rural practice self-efficacy and rural intentions. Logistic regression models explored factors associated with burn-out.Results26.5% of students reported experiencing burn-out during a rural placement. Factors associated with burn-out were female gender, rural origin, low preference for RCS, stress in the year prior to a rural clinical placement, perceived social isolation during rural placement and lower rural practice self-efficacy. Burn-out was not associated with rural career intentions. Social isolation and low rural self-efficacy were independently associated with burn-out during rural placement and together explained 10% of variance in burn-out (Model Nagelkerke R2=0.23).ConclusionBurn-out during rural placement may be a consequence of stress prior to a medical school placement. Social isolation and rural self-efficacy are amendable factors to mitigate medical student burn-out during rural placements.

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Assessment of correlates of hand hygiene compliance among final year medical students: a cross-sectional study in the Netherlands

BMJ Open ◽

10.1136/bmjopen-2019-029484 ◽

2020 ◽

Vol 10 (2) ◽

pp. e029484

Author(s):

Vicki Erasmus ◽

Suzie Otto ◽

Emmely De Roos ◽

Rianne van Eijsden ◽

Margreet C Vos ◽

...

Keyword(s):

Risk Perception ◽

Medical Students ◽

The Netherlands ◽

Hand Hygiene ◽

Self Efficacy ◽

Hand Hygiene Compliance ◽

Secondary Outcome ◽

Factual Knowledge ◽

Cross Sectional ◽

Hygiene Compliance

ObjectivesTo identify the factors that influence the hand hygiene compliance of final year medical students, using a theoretical behavioural framework.DesignCross-sectional survey assessing self-reported compliance and its behavioural correlates.SettingInternships of medical students in the Netherlands.Participants322 medical students of the Erasmus Medical Center were recruited over a period of 12 months during the Public Health internship, which is the final compulsory internship after an 18-month rotation schedule in all major specialities.Primary and secondary outcome measuresBehavioural factors influencing compliance to hand hygiene guidelines were measured by means of a questionnaire based on the Theory of Planned Behaviour and Social Ecological Models. Multiple linear regression analysis was used to identify the effect of including attitudes, social norms, self-efficacy, knowledge, risk perception and habit on hand hygiene compliance.ResultsWe included 313 students in the analysis (response rate 97%). The behavioural model explained 40% of the variance in self-reported compliance (adjusted R2=0.40). Hand hygiene compliance was strongly influenced by attitudes (perceived outcomes of preventive actions), self-efficacy (perception of the ability to perform hand hygiene at the clinical ward) and habit, but was not associated with knowledge and risk perception.ConclusionsTargeting medical students’ behaviour should focus on the empowerment of these juniors and provide them with evidence on the health benefits of prevention, rather than increasing their factual knowledge of procedures. Clinical teaching environments could help them form good patient safety habits during this vital phase of their career.

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Prescribing competency assessment for Canadian medical students: a pilot evaluation

Canadian Medical Education Journal ◽

10.36834/cmej.61646 ◽

2019 ◽

Vol 10 (1) ◽

pp. e103-110 ◽

Cited By ~ 1

Author(s):

Anne Holbrook ◽

J. Tiger Liu ◽

Michael Rieder ◽

Michelle Gibson ◽

Mitchell Levine ◽

...

Keyword(s):

Medical Student ◽

Medical Students ◽

Medical Schools ◽

Ease Of Use ◽

Student Feedback ◽

Assessment Process ◽

Secondary Outcome ◽

Competency Assessment ◽

Perceived Fairness ◽

Discriminative Ability

Background: The knowledge and ability to prescribe safely and effectively is a core competency for every graduating medical student. Our previous research suggested concerns about medical student prescribing abilities, and interest in a standardized assessment process. Methods: A multi-year cross-sectional study evaluating the feasibility, acceptability, and discriminative ability of an online prescribing competency assessment for final year Canadian medical students was conducted. Students at nine sites of four Ontario medical schools were invited to participate in an online one-hour exam of eight domains related to prescribing safely. Student feedback on perceived fairness, clarity, and ease of use formed the primary outcome. Exam performance and parity between schools were the secondary outcome. Results: A total of 714 students completed the assessment during spring final review courses between 2016 and 2018. Student feedback was more favourable than not for appropriateness of content (53.5% agreement vs 18.3% disagreement), clarity of questions (65.5% agreement vs 11.6% disagreement), question layout and presentation (70.8% agreement vs 12.2% disagreement), and ease of use of online interface (67.1% agreement vs 13.6% disagreement). Few (23.6% believed their course work had prepared them for the assessment. Mean total exam score was 70.0% overall (SD 10.4%), with 47.6% scoring at or above the pass threshold of 70%. Conclusion: Our prescribing competency assessment proved feasible, acceptable, and discriminative, and indicated a need for better medical school training to improve prescribing competency. Further evaluation in a larger sample of medical schools is warranted.

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Factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-052609 ◽

2021 ◽

Vol 11 (10) ◽

pp. e052609

Author(s):

Jianbo Shao ◽

Hong Xu ◽

Zhixi Liu ◽

Xiaohua Ying ◽

Hua Xu ◽

...

Keyword(s):

Cohort Study ◽

Outcome Measures ◽

Clinical Features ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Antiviral Drugs ◽

Secondary Outcome ◽

Rt Pcr ◽

Factors Associated ◽

Paediatric Patients

ObjectiveThis study aimed to describe the epidemiological and clinical features and potential factors related to the time to return negative reverse transcriptase (RT)-PCR in discharged paediatric patients with COVID-19.DesignRetrospective cohort study.SettingUnscheduled admissions to 12 tertiary hospitals in China.ParticipantsTwo hundred and thirty-three clinical charts of paediatric patients with confirmed diagnosis of COVID-19 admitted from 1 January 2020 to 17 April 2020.Primary and secondary outcome measuresPrimary outcome measures: factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients. Secondary outcome measures: epidemiological and clinical features and laboratory results in paediatric patients.ResultsThe median age of patients in our cohort was 7.50 (IQR: 2.92–12.17) years, and 133 (57.1%) patients were male. 42 (18.0%) patients were evaluated as asymptomatic, while 162 (69.5%) and 25 (10.7%) patients were classified as mild or moderate, respectively. In Cox regression analysis, longer time to negative RT-PCR was associated with the presence of confirmed infection in family members (HR (95% CI): 0.56 (0.41 to 0.79)). Paediatric patients with emesis symptom had a longer time to return negative (HR (95% CI): 0.33 (0.14 to 0.78)). During hospitalisation, the use of traditional Chinese medicine (TCM) and antiviral drugs at the same time is less conducive to return negative than antiviral drugs alone (HR (95% CI): 0.85 (0.64 to 1.13)).ConclusionsThe mode of transmission might be a critical factor determining the disease severity of COVID-19. Patients with emesis symptom, complications or confirmed infection in family members may have longer healing time than others. However, there were no significant favourable effects from TCM when the patients have received antiviral treatment.

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Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial

JMIR Formative Research ◽

10.2196/21432 ◽

2021 ◽

Vol 5 (2) ◽

pp. e21432

Author(s):

Erlendur Egilsson ◽

Ragnar Bjarnason ◽

Urdur Njardvik

Keyword(s):

Mental Health ◽

Health Behavior ◽

Outcome Measures ◽

Self Efficacy ◽

Secondary Outcome ◽

Specific Information ◽

Attrition Rates ◽

Mhealth Intervention ◽

Randomized Controlled ◽

Time Specific

Background The majority of adolescents own smartphones, although only 8% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed. Objective The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention’s usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health. Methods A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted α levels through Bonferroni corrections were used to assess main outcome effects. Results The attrition from initiation of the intervention to 6-week follow up was 35%. Attrition started in the third week of the intervention and was related to daily time of app usage (Rt=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61% in the intervention group but dropped by 26.21% among controls. Self-efficacy levels increased by 8.23% in the invention arm compared to a 3.03% decrease in the control group. Conclusions This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants’ self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates.

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Using evaluation to improve medical student rural experience

Australian Health Review ◽

10.1071/ah14195 ◽

2016 ◽

Vol 40 (2) ◽

pp. 174 ◽

Cited By ~ 1

Author(s):

Jennifer J. Moffatt ◽

Janine E. Wyatt

Keyword(s):

Medical Education ◽

Medical Students ◽

Outcome Measures ◽

Response Rate ◽

Rural Setting ◽

Clinical Placement ◽

Rural Medicine ◽

Education Experience ◽

Rural Medical Education ◽

Ongoing Evaluation

Objective The aim of this evaluation was to see whether interventions implemented to improve the Rural Medicine Rotation made this a more effective rural medical education experience. Multiple interventions targeting the student experience, lecturers and preceptors were implemented. Methods A quasi-experimental design using pre- and post-measures was used. The participants were all University of Queensland, School of Medicine, Rural Medicine Rotation students who completed the 2009 and 2010 rural medicine rotation evaluations. There were 769 students, with an 84% response rate in 2009 and an 80% response rate in 2010. In addition, all the 25 program preceptors who were visited in 2009 and the 34 who were visited in 2010 participated in the study. Results The implementation of interventions resulted in significant improvement in three outcome measures, namely teaching effectiveness, provision of an environment supportive of learning in a rural/remote setting and opportunities for professional growth. Two of the three other outcome measures – ensuring a safe clinical placement and opportunities for procedural skills experience and development – were very positively evaluated in both 2009 and 2010. Conclusions The interventions contributed to a more effective rural medical education experience, providing students with the opportunity to develop skills and knowledge relevant for rural medicine and to gain an understanding of the context in which rural medicine is practiced. What is known about the topic? Many Australian medical schools offer students rural-based educational opportunities based on the premise that placing medical students in a rural setting may ultimately lead to them choosing careers in rural medicine. However, there is a paucity of evidence on the factors that are considered necessary for medical students to gain a positive rural experience of short conscripted rural placements. What does the paper add? This paper identifies successful interventions to the rotation and placements that provide a positive experience of the rural clinical placement for students. These interventions occurred within an ongoing evaluation program embedded in the rotation. What are the implications for practitioners? Through ongoing evaluation, interventions can be selected and implemented that succeed in contributing to students having a positive rural clinical placement experience. This paper demonstrates how an embedded continuous improvement program serves to provide direction for ongoing modifications.

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Factors associated with social isolation and being homebound among older patients with diabetes: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-037528 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037528

Author(s):

Satoshi Ida ◽

Ryutaro Kaneko ◽

Kanako Imataka ◽

Kaoru Okubo ◽

Yoshitaka Shirakura ◽

...

Keyword(s):

Social Isolation ◽

Functional Capacity ◽

Older Patients ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Patients With Diabetes ◽

Insulin Use

ObjectiveWe aimed at investigating factors associated with social isolation and being homebound in older patients with diabetes.DesignCross-sectional study.SettingsThose undergoing outpatient treatments at Ise Red Cross Hospital, Mie Prefecture.ParticipantsPatients with diabetes aged ≥65 years.Primary and secondary outcome measuresSocial isolation was defined as indulging in less than one interaction per week with individuals other than cohabiting family members. We defined homebound as going outside home less than once a day. To identify factors associated with social isolation and being homebound, we performed logistic regression analysis. The dependent variable was social isolation or homebound and independent variables were basic attributes, glycaemic parameters, complications and treatment details.ResultsWe analysed 558 cases (320 men and 238 women). Among these, 174 (31.2%) were socially isolated; meanwhile, 87 (15.6%) were homebound. The glycoalbumin/haemoglobin A1c ratio (OR 4.52; 95% CI 1.07 to 19.1; p=0.040) and the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) scores (OR 0.72; 95% CI 0.57 to 0.90; p=0.006) had significant associations with social isolation. TMIG-IC scores (OR 0.78; 95% CI 0.66 to 0.92; p=0.003) and insulin use (OR 4.29; 95% CI 1.14 to 16.1; p=0.031) were associated with being homebound.ConclusionIn older patients with diabetes, glycaemic fluctuations and insulin use are associated with social isolation and being homebound, respectively. In addition, a decline in higher level functional capacity is a common factor associated with social isolation and being homebound. Thus, it is important to pay attention to social isolation and being homebound when a decline in higher level functional capacity, increased glycaemic fluctuations and insulin use in older patients with diabetes are observed.

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Factors associated with the mental health status of medical students during the COVID-19 pandemic: a cross-sectional study in Japan

BMJ Open ◽

10.1136/bmjopen-2020-043728 ◽

2020 ◽

Vol 10 (12) ◽

pp. e043728

Author(s):

Makiko Arima ◽

Yusuke Takamiya ◽

Atsuko Furuta ◽

Kris Siriratsivawong ◽

Shizuma Tsuchiya ◽

...

Keyword(s):

Mental Health ◽

Regression Analysis ◽

Psychological Distress ◽

Medical Students ◽

Self Efficacy ◽

Self Esteem ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

ObjectiveThe COVID-19 pandemic had a substantial impact on university students, including those in medical schools, with disruption in routine education causing significant psychological distress. The objective of this study was to evaluate the factors associated with psychological distress among medical students during the period of enforced home quarantine from March through May 2020.DesignA cross-sectional study.SettingOne Japanese medical school.Participants571 medical students.Primary and secondary outcome measuresSelf-administered electronic questionnaires including the K-6 scale for psychological distress, the Rosenberg Self-Esteem Scale (RSES) for self-esteem and the General Self-Efficacy Scale (GSES) for self-efficacy were distributed. To assess the determinant factor for psychological distress, variables such as sex, grade in school, living conditions, and RSES and GSES scores were evaluated in regression analysis.Results163 respondents (28.5%) scored ≥5 on the K-6 scale, indicating a significant degree of psychological distress. Logistic regression revealed that a higher score on RSES (p<0.001) and GSES (p<0.01) was an independent factor associated with lower levels of psychological distress. Multiple regression analysis focusing on students with a K-6 score ≥5 revealed that higher scores on RSES correlated with lower levels of psychological distress. By contrast, those with higher GSES scores also scored higher for indicators of psychological distress.ConclusionsThis study identified that self-efficacy and self-esteem were both influential factors for predicting psychological distress during the current COVID-19 pandemic. Medical schools should provide support for mental health and educational initiatives directed at enhancing self-esteem and self-efficacy, with a focus on improving personal resilience. In emergency situations, such as that faced in response to the COVID-19 pandemic, initial programmes might target students with higher levels of self-efficacy. By contrast, under routine situations, these efforts should be directed towards students with lower self-esteem as primary means to prevent depression.

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Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis

BMC Medical Education ◽

10.1186/s12909-021-02517-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Edouard Leaune ◽

Violette Rey-Cadilhac ◽

Safwan Oufker ◽

Stéphanie Grot ◽

Roy Strowd ◽

...

Keyword(s):

Systematic Review ◽

Medical Education ◽

Medical Student ◽

Medical Students ◽

Student Attitudes ◽

Meta Analysis ◽

Educational Interventions ◽

Factors Associated ◽

Students Attitudes ◽

Medical Student Attitudes

Abstract Background Experts in the field of medical education emphasized the need for curricula that improve students’ attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students’ attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved. Method We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved. Results Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome. Conclusions Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

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Usage and weekly attrition from a smartphone based health behaviour intervention for adolescents: Pilot study (Preprint)

10.2196/preprints.21432 ◽

2020 ◽

Author(s):

Erlendur Egilsson ◽

Ragnar Bjarnason ◽

Urdur Njardvik

Keyword(s):

Mental Health ◽

Pilot Study ◽

Outcome Measures ◽

Health Behaviour ◽

Self Efficacy ◽

Secondary Outcome ◽

Specific Information ◽

Attrition Rates ◽

Mhealth Intervention ◽

Time Specific

BACKGROUND Majority of adolescents own smartphones though only 8% of them use health apps. Attrition rates from adolescent mHealth interventions treating mental health problems, such as anxiety and depression, are an issue with high degree of variation and attrition rates. Attrition in mHealth interventions targeting adolescent populations is frequently presented in two-point fashion, from initiation of intervention to end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide avenue to lower attrition rates though a better understanding of the relationship between mental health factors and time specific attrition rates is needed. OBJECTIVE The study aimed at obtaining time-specific attrition rates among adolescents in an mHealth intervention and describe the intervention’s usage and feasibility in relation to adolescent self-efficacy levels, emotional- and physical health. METHODS A single-centre, randomized controlled elementary school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6-weeks while in-app activity and attrition rates were continually assessed throughout intervention period. Primary outcome was attrition based on time and type of in-app health behaviour usage and feasibility of mHealth app. Secondary outcome measures were self-efficacy levels, depressive- and anxiety symptoms as well as BMI-SDS and sleep. Analyses of group mean variances with adjusted alpha levels through Bonferroni corrections were used to assess main outcome effects. RESULTS Attrition from initiation of intervention to 6-weeks follow-up was 35%. Attrition started in 3rd week of intervention and was related to daily time of app usage (Rt = 0.43, p <.05.). Average weekly in-app health exercises decreased significantly from 1st week of intervention (M = 55.25, SD = 10.96) to the next (M = 13.63, SD = 2.94). However, usage increased by 22% between week 2 and last week of intervention (M = 16.69, SD = 8.37). Usability measures revealed satisfactory scores or 78.09 (SD = 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61% in intervention group while dropping by 26.21% among controls. Self-efficacy levels were increased by 8.23% in invention arm compared to 3.03% decrease in control group. CONCLUSIONS This pilot study demonstrated the feasibility and usability of a mHealth intervention among adolescent participants. Indications were towards beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants’ self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates. CLINICALTRIAL

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Rural self-efficacy measuring intent for rural practice among Japanese medical students

Rural and Remote Health ◽

10.22605/rrh4791 ◽

2018 ◽

Author(s):

Ryuichi Kawamoto ◽

Daisuke Ninomiya ◽

Taichi Akase ◽

Asuka Uemoto ◽

Teru Kumagi

Keyword(s):

Medical Students ◽

Self Efficacy ◽

Rural Practice

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