Effects of medical school on mental health and sleep habits

BACKGROUND and OBJECTIVES: This study aims to define changes in anxiety and depression among medical students while evaluating the association of sleep habits and other risk factors, including exercise habits and a diagnosis of chronic disease. The effect of the COVID-19 pandemic was also evaluated. DESIGN: A cohort of first- and second-year medical students was evaluated longitudinally using survey methods to quantify changes from pre-medical school and summer break to each semester in medical school throughout years one and two. METHODS: Data was analyzed using Generalized Linear Mixed Models (GLMMs) on the numeric responses of General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburg Sleep Quality Index. Additional assessments evaluated exercise habits, chronic disease, and impact of COVID-19 Pandemic. RESULTS: Depression, anxiety, and sleep habits displayed a cyclical change that was associated with the academic cycle. The COVID-19 pandemic was never significant. Medical students who had a chronic disease diagnosis had increased severity. Exercise did not play a role. CONCLUSION: The main driver for depression, anxiety, and poor sleep quality was the academic cycle, while the COVID-19 pandemic did not have an impact on mental health.

Pedagogical and Personal Experiences Motivating Indigenous Students to Pursue Medical Studies

When it comes to accessibility to healthcare and medical education, inequalities prevail within ethnically diverse populations, especially among Indigenous Peoples. The main objective of this qualitative study was to explore how Indigenous female medical students’ motivations played a role in their pursuit of a medical career. We use the Self-Determination theory to frame this study and conduct individual open-ended interviews with four female Indigenous students’ regarding their motivational sources for applying to medical school. We provide an illustrative scenario for each identified motivational source through a thematic analysis. Results revealed two main sources of motivations: (Jones et al., Acad Med, 2019, 94 (4), 512–519) pedagogical experiences (i.e., contextual factors at school, academic interests, and opportunities) and (Sloof et al., Med Educ, 2021, 55 (5), 653) personal experiences (i.e., family support and influence, and future career prospects). Indigenous students’ personal experiences were more prevalent and described autonomous forms of motivations, whereas sources of motivation that were pedagogically oriented reflected more controlled forms of motivations. Different types of motivations can be useful, but not sufficient for the tipping point when the time comes for medical school applications. Learning about specialized Indigenous streams for admissions played the most influential role in students’ decision-making to pursue medical studies. Promoting the visibility of the Indigenous stream coupled with the identification of different forms of motivation could be informative when outlining evidence-based recommendations with the aim of improving inequalities within the health professions.

XTRA Study Protocol: eXploring medical sTudents caReer reAdiness - A cross sectional study in the UK

Background and objectives: Professional and career enhancing opportunities are essential for developing skills required for a successful career in medicine. Research to date has mainly focused on the extent to which medical schools prepare students for clinical work as junior doctors. However, there remains a need to ascertain how students prepare for their career and what facilitates or hinders learning regarding careers in medicine. The purpose of the XTRA study is to examine career readiness of medical students at UK universities and the support they receive during their studies regarding career planning. Methods: The eXploring medical sTudents caReer reAdiness (XTRA) study is a national cross sectional study of all medical students enrolled at a UK medical school. Data collection will occur via a secure online survey designed as a training need analysis based on the principles of Supers theory (Super, 1953) of career development. A snowball sampling strategy will be used to recruit participants via social media and networks. Results will be analysed using quantitative analysis and thematic analysis to identify themes in qualitative responses. The primary outcome is to understand the perspective of current medical students on how well prepared they are about entering their careers in healthcare. Conclusions: We anticipate that findings from this study will help identify career readiness of medical students to facilitate the development of career development programmes and resources to ensure medical students are well equipped for their future careers. Keywords: medical education; medical school; medical students; careers; hidden curriculum; extracurriculars; career readiness.

Reflections on a journey, doing unfinished business, and homage to Balfour Mount

As a medical student at McGill in 1972, I was honored to meet Dr. Balfour Mount. He made it possible for me to accompany him to St. Christopher’s Hospice. We were 8 students from all over the world. Dr. Cicely Saunders felt the best way to learn to be with dying patients was to work as a nurse. So, in that summer of my third year of medical school, I did. My career has gone on, first at Mc Gill and since 1987 at UC San Diego. I have been privileged to teach generations of students and faculty a humanistic empowering model of healthcare, seeing the patient as teacher. Our role is to create environments where people take charge of their lives and achieve wellbeing. My first teacher in doing unfinished business was my father. I was 17. He was 72. He had a MI, called me and my mother into the CCU and said, “The last 25 years with you and Ellen have been the best years of my life. If I should die, I want to say thank you and goodbye.” Then he lived for 20 years and we got to know each other. Present at these moments in people’s lives, we can facilitate unfinished business, whether a mother with cancer, who wrote letters for the next 20 years of her daughter’s life, knowing she wouldn’t be there, a Somali family saying goodbye in the ICU to a loved one or my Dad, opening doors to the future.

Benefits of semiology taught using near-peer tutoring are sustainable

Background Near-peer tutoring appears to be an efficient approach for teaching clinical skills. However, the clinical experience gained in the form of student medical internships may offset any interest in such tutoring programme. We then investigated the long-term benefits of this programme. Methods This study was conducted in a medical school that experimented in near-peer tutoring for semiology intended for undergraduate medical students. Objective Structured Clinical Examinations and a written semiology test were used to assess students’ clinical skills immediately on its conclusion and repeated one and 2 years after the tutoring was completed. Results 116 students were evaluated initially (80 tutored and 36 untutored), 38 at 1 year (16 tutored and 22 untutored), 42 at 2 years (21 tutored and 21 untutored). In the global score for Objective Structured Clinical Examinations: at 1 year, the tutored group scored 14.0 ± 1.05 and the untutored group scored 11.3 ± 2.3 (p < 0.001), at 2 years, the tutored group scored 15.1 ± 1.5 and the untutored group scored 12.4 ± 2.2 (p < 0.001). We found a similar but smaller difference for the written semiology test. The difference for Objective Structured Clinical Examinations between tutored and untutored students vanished over time for cross-cutting skills. Conclusions Near-peer tutoring in semiology for undergraduate medical students led to better results that remained with the passing of time. Though internships do allow an improvement in the clinical skills of untutored students, they did not reach the level of tutored students.

Climate Surveys of Biomedical PhD Students and Training Faculty Members in the Time of Covid

In July 2020, four months into the disruption of normal life caused by the Covid-19 pandemic, we assessed the institutional climate within the School of Medicine. Voluntary surveys were completed by 135 graduate students in 11 PhD-granting programs and by 83 members of the graduate training faculty. Several themes emerged. PhD students work hard, but the number of hours spent on research-related activities has declined during the pandemic. The students are worried about the pandemic's impact on their research productivity, consequent delays in their graduation, and diminished future job prospects. Many late stage PhD students feel they do not have adequate time or resources to plan for their future careers. Symptoms of anxiety and/or depression are prevalent in 51% of the students, based on answers to standardized questions. Most students report they have strong mentoring relationships with their faculty advisors and like their programs, but they identify to a lesser extent with the medical school as a whole. Faculty think highly of their graduate students and are also worried about the pandemic's impact upon productivity and the welfare of students. Students are interested in access to an Ombuds office, which is currently being organized by the medical school. Moving forward, the school needs to address issues of bias, faculty diversity, support for mentor training, professional development, and the imposter syndrome. We must also work to create a climate in which many more graduate students feel that they are valued members of the academic medicine community.

A focus on the future of opioid prescribing: implementation of a virtual opioid and pain management module for medical students

Background The United States opioid epidemic is a devastating public health crisis fueled in part by physician prescribing. While the next generation of prescribers is crucial to the trajectory of the epidemic, medical school curricula designated to prepare students for opioid prescribing (OP) and pain management is often underdeveloped. In response to this deficit, we aimed to investigate the impact of an online opioid and pain management (OPM) educational intervention on fourth-year medical student knowledge, attitudes, and perceived competence. Methods Graduating students completing their final year of medical education at Sidney Kimmel Medical College of Thomas Jefferson University were sent an e-mail invitation to complete a virtual OPM module. The module consisted of eight interactive patient cases that introduced topics through a case-based learning system, challenging students to make decisions and answer knowledge questions about the patient care process. An identical pre- and posttest were built into the module to measure general and case-specific learning objectives, with responses subsequently analyzed using the Wilcoxon matched-pairs signed-rank test. Results Forty-three students (19% response rate) completed the module. All median posttest responses ranked significantly higher than paired median pretest responses (p < 0.05). Comparing the paired overall student baseline score to module completion, median posttest ranks (Mdn = 206, IQR = 25) were significantly higher than median pretest ranks (Mdn = 150, IQR = 24) (p < 0.001). Regarding paired median Perceived Competence Scale metrics specifically, perceived student confidence, capability, and ability in opioid management increased from “disagree” (2) to “agree” (4) (p < 0.001), and student ability to meet the challenge of opioid management increased from “neither agree nor disagree” (3) to “agree” (4) (p < 0.001). Additionally, while 77% of students reported receiving OP training in medical school, 21% reported no history of prior training. Conclusion Implementation of a virtual, interactive module with clinical context is an effective framework for improving the OPM knowledge, attitudes, and perceived competence of fourth-year medical students. This type of intervention may be an important method for standardizing and augmenting the education of future prescribers across multiple institutions.