Stress, Burnout and Coping Strategies in Preclinical Medical Students.

IntroductionBurnout in medical students is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor perception of the educational environment. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve medical student wellness.MethodsOur resilience curriculum consisted of facilitated workshops to cultivate resilience in medical students during their core clerkship rotations. This curriculum served as an introduction to the concept of resilience and taught skills to cultivate resilience and promote wellness. The sessions allowed for identification of and reflection on stressors in the clinical learning environment, including straining team dynamics, disappointment, and uncertainty. Educational sessions included resilience skill-building exercises for managing expectations, letting go of negative emotions, dealing with setbacks, and finding meaning in daily work. Associated materials included lesson plans for small-group facilitators, learner pre- and postcurriculum surveys, and a social media activity guide.ResultsThis curriculum was delivered to 144 clerkship students at two academic institutions over the 2017–2018 academic year. Sessions were well received by medical students, with the majority of students stating that the sessions should continue. The majority of attendees found the sessions valuable and learned new ways to approach challenges.DiscussionStudents valued connecting with peers and feeling less alone through their participation. A challenge was constructing a setting conducive to comfortable reflection for all learners. Not all students found these sessions necessary. Sessions may have improved resilience levels.

Educational experts affirm that students prefer various type of learning preference. It is known that the learning style preferences vary among medical students worldwide. Knowing the types will help medical educators to improve their way of conveying lectures and teaching in a more effective learning environment. This study aims to describe the learning style preferences of pre-clinical medical students and the association with their socio-demography. This is a cross sectional study done among Year 1 and Year 2 pre-clinical year medical students in a public university in Kuantan Pahang. Medical students who fulfilled the inclusion and exclusion criteria were recruited using systematic random sampling. A validated learning style questionnaire (VARK) was used to assess their learning style. Descriptive statistics and bivariable analysis was used using SPSS version 23. A total of 166 pre-clinical year medical students participated in this study. The mean age was 21.3 (0.84). Majority of them were Malays (98.2%) and females (69.9%). Most of the students preferred unimodal learning style (80.0%) with the most preferred learning style preferences being kinaesthetic (39.1%). Bivariable analysis showed female students preferred kinesthetic learning style compared to male students (p=0.03). In this study, majority of the pre-clinical year medical students preferred ‘life-like’ learning experience in their study. Hence, we recommend that medical educators to be more aware of the varieties of learning style preferences in order to improve the quality of teaching and learning experiences.

Extracurricular activities associated with stress and burnout in preclinical medical students

It is questionable whether the Maslach Burnout is suitable for studying burnout prevalence in preclinical medical students because many questions are patient-centered and the students have little or no contact with patients. Among factors associated with burnout in medical students, the gender shows conflicting results. The first aim of this study was to investigate the prevalence of the risk of burnout in medical students in preclinical and clinical years of training, using the Maslach Burnout Inventory-Student Survey, specifically designed and validated to assess the burnout in university students, and secondly, to investigate the association between gender and burnout subscales. A cross-sectional study was carried out in a sample of 270 Spanish medical students-176 (65%) in the third year and 94 (35%) in the sixth year of training-using the Maslach Burnout Inventory-Student Survey questionnaire. Internal consistencies (Cronbach's alpha) for the three subscales on the whole sample were as follows: for exhaustion 0.78, cynicism 0.78, and efficacy 0.71. Moreover, the prevalence of burnout risk was significantly higher in sixth-year students 35 (37.5%) compared with students in third year of training 26 (14.8%) (χ(2) test, p<0.0001). No significant association was found between gender and burnout subscales. The Maslach Burnout Inventory-Student Survey overcame difficulties encountered when students have little or no contact with patients. Our findings show that the risk of burnout prevalence doubled from the third year to sixth year of training and that gender was not significantly associated with any of the subscales of burnout.

BackgroundToday’s medical students are the future physicians of people living with HIV/AIDS (PLWHA). It is therefore essential that medical students possess the appropriate knowledge and attitudes regarding PLWHA. This study aims to evaluate knowledge and attitudes of pre-clinical Israeli medical students and to assess whether their knowledge and attitudes change throughout their pre-clinical studies.MethodsA cross-sectional study was conducted among all pre-clinical medical students from the four medical schools in Israel during the academic year of 2010/2011 (a total of 1,470 students). A self-administered questionnaire was distributed. The questionnaire sought student responses pertaining to knowledge of HIV transmission and non-transmission routes, basic knowledge of HIV/AIDS treatment and attitudes towards HIV/AIDS.ResultsThe study’s response rate was 62.24 percent. Knowledge among pre-clinical medical students was generally high and showed a statistically significant improvement as students progressed through their pre-clinical studies. However, there were some misconceptions, mostly regarding HIV transmission via breastfeeding and knowledge of HIV prevention after exposure to the virus. Students’ attitudes were found to include stigmatizing notions. Furthermore, the majority of medical students correlated HIV with shame and fear. In addition, students’ attitudes toward HIV testing and providing confidential medical information were contradictory to health laws, protocols and guidelines. Overall, no positive changes in students’ attitudes were observed during the pre-clinical years of medical school.ConclusionThe knowledge of pre-clinical medical students in Israel is generally high, although there are some knowledge inadequacies that require more emphasis in the curricula of the medical schools. Contrary to HIV-related knowledge, medical students’ attitudes are unaffected by their progression through medical school. Therefore, medical schools in Israel should modify their curricula to include teaching methods aimed at improving HIV-related attitudes and adherence to medical professionalism.

Background: Physician burnout is increasingly recognized as a problem in physician well-being and may negatively affect patient care outcomes. Burnout can begin at any point of training or practice, potentially as early as the first year of medical school. Thus, there is a need to characterize possible burnout in medical students as the first step to optimizing strategies for mitigation. Traditionally, burnout has been studied using survey-based variables; however, identifying novel physiological and molecular biomarkers could allow for the expansion of screening and intervention strategies. Methods: In this pilot prospective cohort study, we followed a group of preclinical 1st and 2nd year medical students (n = 9) at the University of Florida over one academic year of medical school. We collected survey responses (Maslach Burnout Inventory [MBI], Patient Health Questionnaire-9 [PHQ-9], and Perceived Stress Scale [PSS]) and measured a panel of candidate physiological biomarkers of burnout (Inflammatory Cytokine Panel, Heart Rate Variability [HRV], and Leukocyte Telomere Length). Results: In the study participants, MBI composite scores and PHQ-9 scores showed a statistically significant increase over the course of an academic year, indicating higher levels of medical student burnout. Additionally, respondents reported a statistically significant decrease in time devoted to exercise, and we measured a significant increase in body mass index (BMI) during the academic year. PSS scores showed an upward trend which was not statistically significant. Likewise, average leukocyte telomere length trended downward, but the change was not statistically significant. There were no measured changes in the serum concentration of pro-inflammatory cytokines, and time-domain heart rate variability metrics did not differ significantly between timepoints. Conclusions: This pilot study supports the notion that burnout can begin early in medical school and is detectable via survey instruments in first-year and second-year medical students even with a small sample size. Additionally, leukocyte telomere length could potentially be a useful biomarker of burnout with supporting data, but we did not observe any statistically significant changes in inflammatory cytokines or heart rate variability. Further investigation into these potential biomarkers with larger cohort sizes is required to fully characterize their clinical utility.

Theory Burnout is prevalent among medical students and is correlated with negative feelings, behaviors, and outcomes. Empathy is a desired trait for medical students that has been correlated with reduced burnout. The concept of guilt is closely related to concern about the well-being of others; therefore, feelings of guilt may be associated with empathy. Excessive guilt poses an increased risk for internalized distress, symptoms such as anhedonia, and may be related to burnout. The relationship between pathogenic guilt and burnout in medical students is unknown. Hypothesis We hypothesize that pathogenic guilt is present and related to both burnout and empathy in medical students. Methods We conducted a cross-sectional survey study of all students in one medical school. Data were collected in February 2020. The Oldenburg Burnout Inventory (OBLI), Toronto Empathy Questionnaire (TEQ), and Interpersonal Guilt Questionaire-67 (IGQ-67) were used. A modified version of IGQ-67 was used to measure four subscales of pathogenic guilt: survival guilt, separation guilt, omnipotence guilt, and self-hate guilt. Data analyses for this study including screening, evaluation of assumptions, descriptive statistics, reliabilities, one-way ANOVA, and correlation coefficients, were conducted using SPSS version 26. Results Of 300, 168 (56.0%) students participated in the study. Survival, omnipotence, and self-hate classes of pathogenic guilt were positively correlated with burnout. Empathy was correlated with two classes of pathogenic guilt: survival and omnipotence. Empathy was inversely related to burnout (disengagement). Conclusions Pathogenic guilt may be a contributor to burnout in medical students. Guilt should be a target of prevention and treatment in burnout in medical students. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1891544.

Medical students are at a significant risk of experiencing psychological issues, such as burnout. Over the past few years, more studies have been conducted on this topic, producing different results. The purpose of this review was to determine the global pooled prevalence rate and risk factors associated with burnout and its components among undergraduate (pre-intern) medical students. From inception until 30 November 2021, nine electronic databases were used for an electronic search. Using random-effects meta-analysis, we pooled the estimates using the DerSimonian-Laird method. The prevalence of burnout in medical students was the primary outcome of interest. Data were analyzed globally, by country, by research measure. Age and sex were examined as confounders using meta-regression analysis. A random-effects meta-analysis of 42 studies involving 26,824 evaluating the prevalence of burnout in medical students showed an overall prevalence rate 37.23% [32.66%; 42.05%], Q = 2,267.15(41), p < .0001, τ2 = .42, τ = .65, I2 = 98.2%; H = 7.5. Prevalence of emotional exhaustion, depersonalization, and personal accomplishment were 38.08% [30.67%; 46.10%], 35.07% [26.74%; 44.41%], and 37.23% [32.66%; 42.05%], respectively. Variations were observed between countries and research measures. Age (older) and sex (female) were both significant predictors of burnout. The prevalence of burnout in medical students was estimated to be 37.23%. It is urgent that future studies serve as a basis for the development of prevention and treatment programs to prevent and treat burnout in students.

Background:Medical students can and do suffer from mental disorders is a concept yet to get wide acceptance. There are few studies comprehensively evaluating depression, stress, and burnout in medical students, especially in a longitudinal way in India. The current study aims to assess the impact of medical education on the development of psychological morbidities and the role of personality.Materials and Methods:First-year medical students of a leading medical college of India were enrolled on admission and given anonymized, validated, self-administered questionnaires assessing depression, stress, burnout, and personality. This was repeated at the end of 1st year. Data were analyzed independently as questionnaires were anonymized.Results:We found that 1st year of medical college showed a significantly increasing depression (P < 0.01) and stress (P < 0.01). Overall burnout did not increase significantly. However, only disengagement dimension of burnout increased significantly. Personalities with weak capacity to adjust had a significant positive correlation with depression (r = 0.277, P < 0.001) and stress scores (r = 0.210, P = 0.008). However, burnout did not correlate with any of the personality dimensions.Conclusion:Right from the 1st year of medical education students perceive high-stress levels and have a high risk of depression. Burnout starts to creep in at least in the form of disengagement. This study provides a sound groundwork for planning interventions to reduce student's mental morbidity and avoid burnout.

Knowledge-attitude-practice toward swine flu

Self-directed learning (SDL) competency is important for physicians to stay abreast of advances in their field and to provide the best available evidence-based care to their patients. Therefore, an essential responsibility of medical educators is to ensure the development of SDL skills in their students. The first objective of this study was to investigate longitudinally the degree to which medical students were ready to engage in SDL. The second objective was to examine students' perceptions of their SDL development throughout training. A 2-part study of preclinical and clinical medical students was carried out at a midwestern U.S. university. In Study A, a longitudinal assessment of preclinical medical students' readiness to engage in SDL was conducted by administering an SDL readiness survey (SDLRS). In Study B, third- and fourth-year medical students were asked to reflect on their SDL development, in addition to completing the SDLRS. After validating the Hendry and Ginns version of the SDLRS in preclinical medical students during Study A, we found that 3 of the 4 subscales remained constant over the 3 iterations of the survey while the self-determination subscale increased significantly between the first and third iteration of the survey. In Study B, an analysis of the clinical medical students' comments indicated a perceived increase in their SDL abilities and a growing appreciation of SDL. However, the SDLRS scores of clinical students did not differ from the results observed in preclinical students in Study A. The results of the SDLRS indicated that the experience of students in our medical school has a positive influence on self-determination by the end of the preclinical years. Furthermore, analysis of the reflections of clinical students indicated ongoing development of SDL skills throughout their medical school training that were influenced by a wide range of experiences.

Objectives: The prevalence of burnout is progressively rising among medical students. The objective of this study was to evaluate the occurrence and determinants of burnout among preclinical medical students in Muscat. Methods: This cross-sectional analytical research was conducted at one of Oman's top medical universities from October 2019 to April 2020. A cohort of 350 preclinical medical students in their 2nd, 3rd, and 4th years of study participated in this study. The assessment of burnout was based on self-reports from the participants, using the Maslach Burnout Inventory-Student Survey. Various variables were coded and analyzed. Results: A total of 350 students completed the survey (response rate: 83.3%). Burnout was reported by 125 (35.7%) students. Regarding specific domains of burnout, most students demonstrated higher rates of cynicism (n: 236; 67.4%) and emotional exhaustion (n: 221; 63.1%) and lower rates of academic efficacy (n: 197; 56.3%). Burnout was significantly more common among older students (p-value &lt; 0.001), students living apart from their family (p-value: 0.042), students who did not participate in regular exercises (p-value &lt; 0.001), those who spent fewer hours studying per day (p-value &lt; 0.001), those who regretted their decision to study medicine (p-value: 0.023), those who were dissatisfied with examination results (p-value &lt; 0.001), teaching strategies (p-value: 0.029), those with lower cumulative grade point averages (p-value &lt; 0.001), and those with a history of academic probation (p-value &lt; 0.001). Conclusions: Preclinical medical students displayed high rates of burnout. Continuous evaluation programs and educational initiatives are recommended to help such students to develop better burnout management and coping strategies.

Background: An increase of sedentary behavior was observed in each year especially in clinical year. This accounts for a decrease in physical activities (PAs) of medical students, which could lead to reduced overall health and physical performance. Objective: To compare the levels of PA between pre-clinical and clinical medical students of Mae Fah Luang University (MFU) and to explored association between the levels of PA and school year. Materials and Methods: A cross-sectional study was conducted between May and August 2019. Online questionnaire, including personal profiles and global PA questionnaire, were distributed to all MFU medical students currently studying in the academic year of 2019. Results: One hundred fifty-six medical students participated in the present study. From the questionnaires, 67.74% of pre-clinical medical students (n=63) and 52.99% of clinical medical students (n=36) had moderate to high levels of PA. Pre-Clinical students had significantly higher levels of PA by median metabolic equivalent value (MET) at 1,908.73 versus 1,339.05 MET-minutes/week (p=0.03). The sixth-year medical students increased risk of lower PA than the first year about 8.34 times (p&lt;0.01). Conclusion: One-third of the medical students reported as having low levels of PA. Clinical medical students had reduced levels of PA compared to pre-clinical medical students. Therefore, PA should be promoted to help increase the overall health of medical students. Keywords: Physical activity; Metabolic; Equivalent; Medical Student; Clinic; Pre-clinic

Background and Objective:Hepatitis B is an occupational health hazard to health-care workers. The complete knowledge of hepatitis B virus (HBV) transmission and prevention is indispensable for medical students. This study was conducted to assess the knowledge and awareness of hepatitis B among preclinical year medical students.Materials and Methods:This is a descriptive cross-sectional study. A predesigned self-administered questionnaire concerning hepatitis B knowledge and awareness was distributed to all the preclinical year medical students. The data were collected, tabulated, and analyzed by Microsoft Excel and Statistical Package for the Social Sciences (SPSS) software, version 22. The results were expressed in numbers and percentages.Results:Of 251 students, only 132 students voluntarily participated in the study. Majority of the students (84.8%) were aware of HBV infection. Many students knew that blood transfusion (81.1%) and use of contaminated needles and syringes (74.2%) are major modes of transmission. However, less than 30% of the students had knowledge about other modes of transmission. More than 50% of the students lacked in their knowledge about clinical features and complications of hepatitis B infection. Majority of students (72.7%) were aware of HBV vaccination. However, many students did not know their vaccination status, whereas only 23.5% of the students were fully immunized.Conclusion:This study revealed lack of complete knowledge regarding hepatitis B among preclinical year medical students. They are at high risk of acquiring HBV infection during their clinical practice, later in life. Hence, implementation of well-structured education program in the first year itself is needed to create complete awareness among medical students about hepatitis B.

Background: Corticosteroid medications are commonly used in various medical conditions due to their potent anti-inflammatory and immunosuppressive properties. However, corticosteroid phobia, which refers to the fear to use these medications, can impact their appropriate use in clinical practice. Objective: This study aimed to compare the level of Topical corticosteroid (TCS) phobia among pre-clinical and clinical year medical students by using TOPICOP score. Methods: A cross-sectional study was conducted, after obtaining ethical approval, among MBBS students. A pre-tested questionnaire was used to assess TCS phobia, which included knowledge, attitudes, and beliefs about corticosteroids, as well as comfort level in prescribing or administering these in hypothetical clinical scenarios. Data was analyzed using descriptive and inferential statistics, including chi-square test. Results: The study surveyed 286 medical students; 139 of them were Pre-Clinical years students (48.6%), while 147 in Clinical (51.4%). Mean age in Pre-Clinical years was 18.7+1.2 while 21.2+2.8 in Clinical years &amp; 51.4% reported studying pharmacology, which is the subject educating most on the various effects of TCS. Significant findings include: Clinical years students express more concern about TCS affecting future health (26.53% vs 14.39%); Clinical years students are more afraid of applying TCS on thinner skin areas (25.85% vs 21.58%); Clinical years students are more likely to stop TCS treatment early (26.53% vs 10.07%); Clinical years students are more inclined towards non-steroidal alternatives even if more expensive (25.17% vs 14.39%); and Clinical years students perceive more benefit from TCS use (21.09% vs 9.35%). Conclusion: Our findings highlighted a greater sense of caution held by Clinical Years, regarding use of TCS and its potential side effects, while still appreciating its therapeutic role