Shared Living Experiences by Physicians have a Positive Impact on Mental Health Attitudes and Stigma among Medical Students: A Mixed-Methods Study

Introduction: Medical culture can make trainees feel like there is neither room for mistakes, nor space for personal shortcomings in the makeup of physicians. A dearth of role models who can exemplify that it is acceptable to need support compounds barriers to help-seeking once students struggle. We conducted a mixed-methods study to assess the impact of physicians sharing their living experiences with medical students. Methods: Second-year medical students participated, through synchronized videoconferencing, in an intervention consisting of 3 physicians who shared personal histories of vulnerability (e.g. failure on high-stakes exams; immigration and acculturation stress; and personal psychopathology, including treatment and recovery), followed by facilitated, small-group discussions. For the quantitative component, students completed the Opening Minds to Stigma Scale for Health Care Providers (OMS-HC) before and after the intervention. For the qualitative component, we conducted focus groups to explore the study intervention. We analyzed anonymized transcripts using thematic analysis aided by NVivo software. Results: We invited all students in the class (n = 61, 46% women) to participate in the research component. Among the 53 participants (87% of the class), OMS-HC scores improved after the intervention ( P = .002), driven by the Attitudes ( P = .003) and Disclosure ( P < .001) subscales. We conducted 4 focus groups, each with a median of 6 participants (range, 5-7). We identified, through iterative thematic analysis of focus group transcripts, active components before, during, and after the intervention, with unexpected vulnerability and unarmored mutuality as particularly salient. Conclusions: Sharing histories of personal vulnerability by senior physicians can lessen stigmatized views of mental health and normalize help-seeking among medical students. Synchronous videoconferencing proved to be an effective delivery mechanism for the intervention in a ‘virtual wellness’ format. Candid sharing by physicians has the potential to enhance students’ ability to recognize, address, and seek help for their own mental health needs.

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Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

Health Services and Delivery Research ◽

10.3310/hsdr08150 ◽

2020 ◽

Vol 8 (15) ◽

pp. 1-256

Author(s):

Alicia O’Cathain ◽

Emma Knowles ◽

Jaqui Long ◽

Janice Connell ◽

Lindsey Bishop-Edwards ◽

...

Keyword(s):

General Practice ◽

Mixed Methods ◽

General Practitioner ◽

Health Service ◽

Health Services ◽

Focus Groups ◽

Emergency Departments ◽

Help Seeking ◽

Mixed Methods Study ◽

Coping Capacity

Background There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use. Objectives To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives. Design This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking. Results From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice. Limitations Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service. Conclusions Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered. Future work There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions. Study registration This study is registered as PROSPERO CRD42017056273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

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Cross sectional analysis of depression and stress in medical students

10.31234/osf.io/ymfpb ◽

2018 ◽

Author(s):

Tyler S. Jones ◽

Deborah Rupert

Keyword(s):

Mental Health ◽

Medical Students ◽

Help Seeking ◽

Health Issues ◽

Cross Sectional ◽

Help Seeking Behaviors ◽

Mental Health Issues ◽

Increased Risk ◽

Sectional Analysis ◽

The Impact

Medical student wellbeing is a topic of growing concern. Medical students experience high levels of stress and burnout and are at increased risk for depression and suicidal ideation compared to the general population. Even more concerning, medical students are disproportionately less likely to seek help for their mental health issues. Identifying and preventing these problems early can have lasting positive consequences over the course of a physician’s lifetime. We implemented a wellness program at our medical school in the spring of 2016 with the goals of decreasing burnout and depression, heightening awareness of mental health issues, and encouraging help-seeking behaviors. To analyze the impact of our program, we have implemented a quality assurance survey. Here we report lifestyle factors associated with positive screens for depression from that data and propose institutional initiatives that can be spearheaded by medical students for medical students to impact positive change.

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Burnout, resilience, and perception of mindfulness programmes among GP trainees: a mixed-methods study

BJGP Open ◽

10.3399/bjgpopen20x101058 ◽

2020 ◽

Vol 4 (3) ◽

pp. bjgpopen20X101058

Author(s):

Petra Hanson ◽

Amy Clarke ◽

Manuel Villarreal ◽

Majid Khan ◽

Jeremy Dale

Keyword(s):

Mixed Methods ◽

Focus Groups ◽

Help Seeking ◽

High Stress ◽

Mixed Methods Study ◽

Mindfulness Practice ◽

Negative Effects ◽

High Prevalence ◽

High Level ◽

And Coping

BackgroundTrainee GPs are at risk of developing burnout as a result of high stress levels. Improving resilience may prevent the negative effects of stress on wellbeing, morale, and patient care, thereby supporting recruitment to general practice.AimTo explore experiences of stress and burnout among GP trainees, and their level of interest in undertaking a mindfulness programme.Design & settingA qualitative study was performed with a cohort of GP trainees in Coventry and Warwickshire.MethodThis mixed-methods study utilised a survey with validated measures to investigate the prevalence of burnout, state of wellbeing, and resilience in GP trainees. Focus groups were also used to explore experiences of stress and burnout, and perceptions of mindfulness practice.ResultsIn total, 47 (response rate 39%) trainees completed the survey and 14 participated in focus groups. There was a high prevalence of disengagement (n = 36; 80%) and emotional exhaustion (n = 35; 77%), with 29 (64%) scoring above the cut-off value for both. While 16 (34%) reported already practising mindfulness, 39 (83%) described interest in engaging in mindfulness practice. The focus groups identified a range of issues relating to how trainees recognise stress and burnout, their help-seeking and coping strategies, the perceived barriers to practising self-care, and motivations for participating in mindfulness training.ConclusionThis study confirms the degree of stress and burnout that GP trainees experience, and their desire for greater wellbeing and resilience support. It identified a high level of interest in attending a mindfulness programme, but also barriers to engagement. Results of this research shaped the Mindful Practice Curriculum programme, which was later provided to this cohort of trainees.

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Exploring the Effectiveness of an Integrated Mixed Martial Arts and Psychotherapy Intervention for Young Men’s Mental Health

American Journal of Men s Health ◽

10.1177/1557988319832121 ◽

2019 ◽

Vol 13 (1) ◽

pp. 155798831983212 ◽

Cited By ~ 1

Author(s):

N. Bird ◽

G. McCarthy ◽

K. O’Sullivan

Keyword(s):

Mental Health ◽

At Risk ◽

Martial Arts ◽

Role Models ◽

Help Seeking ◽

Help Seeking Behavior ◽

Mixed Martial Arts ◽

Young Males ◽

Seeking Behavior ◽

The Impact

This research sought to establish the impact of a 10-week program combining mixed martial arts (MMA) and one-to-one psychotherapy on young males’ mental health and determine factors that predict help-seeking behavior in at-risk males. Preparticipation and post-participation interviews were employed as the method of data collection. Seven males (20–35 years; M = 24.57) completed preparticipation interviews and five completed follow-up interviews. Thematic analysis of preparticipation revealed that help-seeking behavior in at-risk males is impeded by the presence of male gender stereotypes, the absence of positive role models, as well as difficulty navigating challenging social landscapes. Post-participation interviews revealed that the sport provided structure and fitness for at-risk males, while the counseling was pivotal for personal growth. Improved relationships, work life, and self-esteem were also observed. The sporting element of the program helped to reduce stigma associated with engaging in psychotherapy, and positive male relationships were noted as particularly impactful. Findings support previous research indicating that combining sports and psychotherapy positively impacts young males’ mental health. Sport provides an acceptable doorway to psychotherapy, providing space to explore personal issues.

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Comparison of Medical Students, Medical School Faculty, Primary Care Physicians, and the General Population on Attitudes toward Psychological Help-Seeking

Psychological Reports ◽

10.2466/pr0.2002.91.3f.1268 ◽

2002 ◽

Vol 91 (3_suppl) ◽

pp. 1268-1272 ◽

Cited By ~ 4

Author(s):

Lisa D. Smith ◽

Patrick L. Peck ◽

Rene J. McGovern

Keyword(s):

Mental Health ◽

Primary Care ◽

Medical Students ◽

General Population ◽

Help Seeking ◽

Primary Care Providers ◽

Psychological Help ◽

Care Providers ◽

Medical School Faculty ◽

School Faculty

This study is a preliminary comparison of the attitudes of osteopathic medical students, medical school faculty, primary care providers, and the general population toward seeking professional psychological help. Attitudes were also studied in the former three groups for those who had and had not previously received mental health services. 103 medical students, 22 faculty, 31 primary care providers, and 395 people from the general population responded to the mail-out survey. Attitudes toward help-seeking were more negative among the general population group than among students and providers. For these students, faculty, and providers, attitudes toward seeking help were more positive if they reported having received mental health services in the past.

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Medical Students’ Experiences and Outcomes Using a Virtual Human Simulation to Improve Communication Skills: Mixed Methods Study (Preprint)

10.2196/preprints.15459 ◽

2019 ◽

Author(s):

Timothy C Guetterman ◽

Rae Sakakibara ◽

Srikar Baireddy ◽

Frederick W Kron ◽

Mark W Scerbo ◽

...

Keyword(s):

Health Care ◽

Mixed Methods ◽

Medical Students ◽

Communication Skills ◽

Health Care Providers ◽

Mixed Methods Study ◽

Virtual Human ◽

Care Providers ◽

Empathic Communication ◽

Nonverbal Skills

BACKGROUND Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)–based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial. OBJECTIVE This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication. METHODS We employed a mixed methods intervention design, involving a comparison of 2 quantitative measures—MPathic-VR–calculated scores and the objective structured clinical exam (OSCE) scores—with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis. RESULTS OSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; <italic>F</italic><sub>1,414</sub>=6.09; <italic>P</italic>=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers. CONCLUSIONS VHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills.

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Tutor uncertainty in dealing with unprofessional behaviours of medical students and trainees: a mixed methods study

10.21203/rs.3.rs-55479/v1 ◽

2020 ◽

Author(s):

Dervla Kelly ◽

Diane O'Doherty ◽

Sarah Harney ◽

Natasha Slattery ◽

Louise Crowley ◽

...

Keyword(s):

Mixed Methods ◽

Medical Students ◽

Focus Groups ◽

Identity Formation ◽

Distinct Type ◽

Mixed Methods Study ◽

Medical Teacher ◽

Clinical Teachers ◽

Policies And Procedures ◽

The University

Abstract Background: Despite acknowledgement of medical students’ expected professional behaviours and attitudes, there remains widespread reluctance to report students that behave inappropriately. Existing literature focuses on why faculty fail to fail, overlooking the clinical teachers who deal with students day to day. We investigated how clinical teachers address inappropriate behaviours and attitudes in students and trainees.Methods: A mixed methods study was carried out consisting of a survey and two focus groups with clinical teachers. Seventeen clinical teachers from the at University of Limerick School of Medicine, Ireland, took part in the survey (n=22%) and eight clinical teachers participated in two focus groups during the 2018-2019 academic year.Results: Findings suggested that 59% of tutors would take a different approach in regards to professional identity formation (PIF) between addressing unprofessional behaviours witnessed in medical students and trainees. 88% of tutors said they intervened on a professionalism issue with 52% saying ‘once in a while’ In contrast to the survey, tutors in the focus groups expressed a lack of confidence in addressing some behaviors due to a lack of time, not seeing the outcome of process/remediation etc. Tutors indicated a strong preference for case-based training on assessing PIF.Conclusions: We found tutors typically work closely with students on a day-to-day basis and manage unprofessionalism issues. Clinical tutors valued regular communication about policies and procedures about appropriate conduct as well as support, advice and/or oversight from independent member of the university staff. This research also highlights the need for training designed for busy clinical tutors as a distinct type of medical teacher.

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ESSENTIAL LEADERSHIP DOMAINS AND STRATEGIES TO ENHANCE LEADERSHIP SKILLS AMONG UNDERGRADUATE MEDICAL STUDENTS: A MIXED METHODS STUDY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i5.3760 ◽

2021 ◽

Vol 71 (5) ◽

pp. 1791-96

Author(s):

Syed Muslim Abbas ◽

Abid Ashar

Keyword(s):

Mixed Methods ◽

Medical Students ◽

Undergraduate Students ◽

Role Models ◽

Leadership Skills ◽

National Level ◽

Mixed Methods Study ◽

Framework Analysis ◽

Undergraduate Medical Students ◽

Medical Undergraduate

Objective: To explore medical undergraduate students’ perceptions pertaining to the key domains of leadership and highlight strategies to enhance leadership skills in undergraduate studies. Study Design: Mixed methods study. Place and Duration of Study: Fatima Memorial Hospital College of Medicine & Dentistry, Lahore, from Sep to Oct 2019. Methodology: A total of 207 medical students were recruited from the first and final year by purposive sampling to fill out a structured questionnaire. Three focus group discussions were conducted comprising of twelve students in each group. All focus groups were audio-recorded, anonymized and transcribed verbatim before the analysis by framework analysis technique. Results: Total fifty percent of the first-year students were of the view that ensuring patient safety was an important component of the leadership domain of improving services whereas only 11% responded as critically evaluating as a component of this domain. The themes that emerged pertaining to the strategies to enhance leadership skills included increasing awareness, role models depicting change, cultural challenges, and supplementing existing practices. Conclusions: The validated essential domains of leadership and its associated competencies should be streamlined strategically and prioritized in accordance with the level of training of the undergraduate medical students. A multicentre study is suggested to gather data at the national level which could inform further development of inclusion of leadership domains within undergraduate MBBS curriculum.

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The Impact of COVID-19 on the Mental Health of Autistic Adults in the UK: A Mixed-Methods Study

10.31219/osf.io/9v5qh ◽

2021 ◽

Author(s):

Rebecca Bundy ◽

William Mandy ◽

Laura Crane ◽

Hannah Belcher ◽

Laura Bourne ◽

...

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Online Survey ◽

Negative Impact ◽

Self Regulation ◽

Health Impact ◽

Mixed Methods Study ◽

Autistic People ◽

Autistic Adults ◽

The Impact

The COVID-19 pandemic has been associated with mental health declines in the general population. Those with pre-existing vulnerabilities are known to be at particular risk. This may include autistic people, who have high levels of mental and physical health problems. Yet little is currently known about the impact of the pandemic on autistic people. Using an online survey, this mixed-methods study gathered data from 133 autistic adults in the United Kingdom (UK), about their experiences of the pandemic in relation to their mental health. Results indicated that the mental health impact of the pandemic on autistic adults was variable. A sizeable minority reported improvements in their mental health associated with COVID-19 restrictions. By contrast, most participants described an overall negative impact their levels of depression, anxiety and stress. Analysis of qualitative data using thematic analysis highlighted four themes that contributed to mental health changes in autistic adults: (i) adjusting to changes to the social world, (ii) living with uncertainty, (iii) disruptions to self-regulation, and (iv) barriers to fulfilling basic needs. Based on these findings, we discuss recommendations about how to support autistic people; both as the pandemic persists and once normality ensues.

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Understanding the Barriers and Pathways to Male Help-Seeking and Help-Offering: A Mixed Methods Study of the Impact of the Mates in Construction Program

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16162979 ◽

2019 ◽

Vol 16 (16) ◽

pp. 2979 ◽

Cited By ~ 3

Author(s):

Victoria Ross ◽

Neil Caton ◽

Jorgen Gullestrup ◽

Kairi Kõlves

Keyword(s):

Mixed Methods ◽

Help Seeking ◽

Mixed Methods Study ◽

Individual Interviews ◽

Making A Difference ◽

Before And After ◽

Effectiveness Of Training ◽

Training And Support ◽

The Impact ◽

Suicide Awareness

The Mates in Construction (MATES) program was developed to address the issue of high suicide rates among males in the Australian construction industry. The program delivers early intervention training and support to construction workers. This mixed-methods study aimed to (1) examine the effectiveness of training for MATES connectors and (2) examine the barriers, motivations and pathways to help-seeking and help-offering for both MATES connectors and clients. A total of 104 volunteers completed a short survey before and after connector training sessions. Quantitative data analysis showed significant increases in connectors’ self-reported suicide awareness, and willingness to offer help to workmates and seek help themselves. For the qualitative component, 27 connectors and clients participated in focus groups and individual interviews. Thematic analysis identified six themes from the connectors’ data: awareness, skills and confidence; removing stigma; making a difference; simplicity of the model; understanding the industry; and visibility, camaraderie and passion. For clients, three key themes emerged: barriers and pathways to help-seeking; speaking the same language; and flow-on effects. The results provide evidence for the effectiveness of connector training and indicate that MATES’s peer support model is enabling workers to overcome traditional barriers and attitudes to seeking and offering help.

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