Medical Education Environment Research Articles

IJCM_388A: Sleep disturbances and associated factors among undergraduate medical students in a tertiary health care center in central India: A cross sectional study

Background: Within the rigorous environment of medical education, the well-being of students is a critical concern. Sleep disturbances, a prevalent yet understudied issue, may pose significant challenges to the academics and mental health of medical students. Objective: To assess the sleep disturbances and associated factors among undergraduate medical students in a tertiary health care center. Methodology: A cross-sectional study was conducted among 256 undergraduate medical students in a tertiary health care center from September to November 2023. Study was conducted using self-administered questionnaire consisting of sociodemographic profile and standardized tool Pittsburgh Sleep Quality Index. Descriptive and analytical statistics were used. Results: Out of 256 students,161(62.9%) were suffering from sleep disturbances.72% of them had less than 1 hour time gap between screen time and their regular sleep. There was a significant association between sleep disturbances and repeated worrying about lots of tests, illness during past month, felt isolated and feeling lost something in life. Conclusion: This study showed that majority of undergraduate medical students suffer from sleep disturbances. It becomes evident that fostering a supportive environment and promoting healthy sleep practices are indispensable for the overall wellbeing and success of medical students.

Challenges for international medical graduates in the US and the UK graduate medical education and health care system environment: A comprehensive review

A comprehensive review of past research and statistical data is necessary to understand the significant obstacles encountered by International Medical Graduates (IMGs) in the healthcare systems of the USA and UK. A careful review of the literature shows that financial, cultural, and linguistic barriers are worsened by the intricate USA licensing processes overseen by the ECFMG. The BMJ and the AAMC's research statistics demonstrate the prevalence of these difficulties and their impact on the career trajectories and well-being of IMGs. The study assesses the impact of professional networks, mentoring programs, and support systems in addressing challenges faced by IMGs in the healthcare sectors of the US and UK, emphasizing the significance of evidence-based interventions in developing inclusion and equality. International Medical Graduates (IMGs) play an important role in graduate medical education and broad medical settings, but their integration present challenges that need thoughtful evaluation of many concerns they face.

Defining competencies in robotic thyroidectomy: development of a model assessing an expert operator's intraoperative performance skills and cognitive strategies.

The changing medical education environment emphasizes the need for time efficiency, increasing the demand for competency-based medical education to improve trainees' learning strategies. This study was performed to determine the competencies required for successful performance of robotic thyroidectomy (RT) and to determine the consensus of experts for performance of RT. Data were collected through 12 semi-structured interviews with RT experts and 11 field observations. Cognitive task analysis was performed to determine the competencies required for experts to perform RT. A modified Delphi methodology was used to determine how 20 experts rated the importance of each item of RT performance on a Likert 7-point scale. The criteria for the Delphi consensus were set at a Cronbach's α≥0.80 with two survey rounds. After 11 field observations and 12 semi-structured interviews, 89 items were identified within six modules. These items were grouped into sub-modules according to their theme. The modified Delphi survey, involving 21 experts, reached the consensus standard during the second round (Cronbach's α=0.954), enabling the identification of the 64 most important items within six modules related to RT performance: midline incision to isthmectomy (MID module; n=8), lateral dissection (LAT module; n=7), preservation of inferior parathyroid glands (INF module; n=16), preservation of recurrent laryngeal nerve and dissection of the ligament of Berry (BER module; n=21), dissection of the thyroid upper pole (SUP module; n=10), and specimen removal and closure (END module; n=2). This mixed-method study combining qualitative and quantitative methodology identified modules of core competencies required to perform RT. These modules can be used as a standard and objective guide to train surgeons to perform RT and evaluate outcomes.

Examining the effect of training with a teaching for understanding framework on intravenous therapy administration’s knowledge, performance, and satisfaction of nursing students: a non-randomized controlled study

BackgroundNursing students require improvement in their intravenous infusion therapy management skills, yet traditional training models possess deficiencies. The Teaching for Understanding (TfU) Framework can enhance the teaching-learning process and support quality education. Therefore, utilizing TfU framework for training may promote the performance of nurses.MethodsUtilizing a non-synchronized design, 102 nurses were recruited using a convenience sampling method. Fifty-one student nurses from August 2019 to January 2021 were designated as the control group, and 51 student nurses from February 2021 to July 2022 were included as the intervention group. The control group received traditional teaching methods, while the intervention group was trained based on TfU framework. The impact was gauged through medical education environment perception, theory and practice assessments, and learning satisfaction surveys.ResultsAfter the training, there was no significant difference between the control group and the intervention group in the theory assessment. However, the practice assessment scores of the intervention group were significantly higher than those of the control group. Compared with the control group, the learning satisfaction scores of the trained nurses in the intervention group were significantly higher, exhibiting significant differences, particularly in communication ability, teamwork cooperation, summing up capability, and interest in learning improvement. Furthermore, the scores of the learning perceptions, atmosphere, social self-perceptions, and total scores of the intervention group were significantly higher.ConclusionTraining using TfU framework can heighten students’ understanding and command over knowledge and skills, fuel their learning fervor, and enhance their communication and collaboration abilities. TfU framework should be disseminated in medical education to improve the quality of education.

Satisfaction and readiness for professional activity of students of the Institute of Osteopathy (Saint-Petersburg): a study using the DREEM questionnaire

Introduction. The educational program is an important factor of the training quality of a future specialist in the modern system of medical personnel training. The most important indicator of the educational program quality is the educational environment that influences the formation of competencies and the students′ success. Measurements of the educational environment with the help of developed and validated tools make it possible to change it in many ways, which will eventually improve the quality of medical education. To date, the rapid educational environment assessment system developed at the University of Dundee (Dundee Ready Education Environment Measure, DREEM questionnaire) is considered as a valid and reliable tool that is universally accepted for measuring the medical educational environment, assessing the strengths and weaknesses of the educational environment according to the educational program under study and determining the direction of improving the educational environment. The aim of the study is to evaluate the perception of the educational environment by students of the Institute of Osteopathy (Saint-Petersburg) using the DREEM questionnaire. Materials and methods. The study involved 80 students of the Institute of Osteopathy (Saint-Petersburg), studying in residency or professional retraining programs. Participants were surveyed using the DREEM questionnaire, consisting of 50 closed-ended statements, which are grouped into 5 subcategories. I. Students′ perception of the learning process (12 statements). II. Students′ perception of the role of lecturers in the educational process (11 statements). III. Students′ perceptions of their own academic performance (8 statements). IV. Students′ perceptions of the educational atmosphere (12 statements). V. Social self-perception and interaction with the environment (7 statements). Each of the 50 statements is rated on a 5-point scale: «Strongly agree» (4), «Agree» (3), «Not sure» (2), «Disagree» (1) and «Strongly disagree» (0). Satisfaction analysis was also carried out for individual statements. Results. The analysis of information obtained using the DREEM questionnaire showed that the educational environment created at the Institute of Osteopathy (Saint-Petersburg) was rated by students as ideal — 165,2 points; doctors studying in the residency educational program rate the educational environment statistically significantly (p < 0,05) higher than those studying in the professional retraining program. Among the students studying in a residency program, the indicators of confidence in their readiness for professional activity are at a fairly high level — 3,5–3,7 points, while among the students studying in a professional training program, the indicators of confidence in their readiness for professional activity are at the level of 2–3,3 points. There are some indicators of the educational environment that require improvement. Conclusion. A detailed study of the level of the educational environment perception among students of the Institute of Osteopathy (Saint-Petersburg), studying in various educational programs, made it possible to identify the most problematic areas in the educational process implemented at the Institute, which makes it possible to develop proposals for improving the current educational environment. The issues of organizing social support for students and building confidence in their preparedness for practical activities deserve the greatest attention. It is also recommended to regularly conduct a study of the educational environment satisfaction among students of the Institute of Osteopathy to assess the dynamics of the indicators.

CHALLENGES AND OPPORTUNITIES IN DEVELOPING ENGLISH-LANGUAGE EDUCATIONAL ENVIRONMENT IN MEDICAL EDUCATION DURING CRISIS SITUATIONS

The article deals with the role of English as a language of medical academic instruction in modern conditions that is gaining a particular relevance both in Ukraine and around the world. Knowledge of professional English facilitates the integration into the global scientific and educational space, opens up new opportunities for both students and teachers. Ensuring the quality of education in the context of the coronavirus infection pandemic, time of uncertainty, and military operations is of particular importance. After all, the quality of education depends not only on the scientific and methodological support of academic disciplines, but also on the use of the latest forms and methods of teaching, the relevance of the content to current trends and events in the world, which is impossible without the use of English as a language of international medical communication.
 The purpose of the study is to reveal the characteristic features of the creation of the English-language educational environment in medical education and to determine their role in the perception and assimilation of educational material by students of higher medical education in crisis situations. Poltava State Medical University is diligently striving to establish and maintain a thriving and supportive English-language educational environment.
 The creation of English-language educational environment in medical education and its role in ensuring the professional development of students and teachers of higher medical education is of global importance for further use in professional activities. In crisis situations, its preservation and development is an important area of work of a higher education institution, in particular Poltava state medical university. Hence, it can be stated that the creation of the English-language educational environment at Poltava State Medical University fosters the professional and personal development of both students and teachers, enabling all participants in the educational process to unleash their full potential.

Assessment of mental health and various strategies among Health Professions' (HP) students: A cross sectional study in King Saud Bin Abdulaziz University for Health Sciences.

The education environment of medical colleges is known to have a burdensome effect on the overall mental health of the students. This study aimed to investigate the immediate impact of the medical education environment on mental health and quality of life among Health Profession students and to identify various coping strategies used by students to mitigate the stress. An online survey was conducted between April 1 and May 10, 2021, using a validated questionnaire based on DASS-42, employing a snowball sampling technique. A total of 338 students filled the questionnaire. The respondents had a high level of depression and anxiety scores, categorized as very severe which were significantly different among level of education (P < .05), for example, 88.9% of sixth year students had very severe depression compared to just 37% of first year ones. Gender-wise very severe scores varied from lowest 45.8% to 70.3% with comparable results for both males and females. Additionally, more than 30% of the students listed that the amount of material to be covered, lack of time to study the material to be tested, heavy demand to study, concern about trying to learn all the content, and competitiveness among students to be the top reason which affect their mental state of mental health. This study identifies the need to provide the free professional and psychological services to help cope with stress to the health profession students.

Teaching Future Teachers: Development of a Students-as-Teachers Advanced Elective for Post-Clerkship Medical Students.

Although teaching is an essential part of Graduate Medical Education and the practice of medicine, it is not often formally taught in Undergraduate Medical Education. Vanderbilt University School of Medicine (VUSM) has addressed this gap by creating a year-long Students-as-Teachers elective for post-clerkship medical students. The elective utilizes diverse activities to emphasize core tenets of medical education theory while simultaneously providing authentic teaching opportunities. The success of the elective is primarily attributable to its structure and design, the collaborative and supportive medical education environment, and student initiative and engagement. This manuscript describes the implementation and outcomes of the Students-as-Teachers elective.

Medical education environment perception and learning engagement in undergraduate nursing students: The mediating effect of self-regulated learning ability

AimTo investigate the interrelationships of medical education environment perception, learning engagement and self-regulated learning ability among Chinese undergraduate nursing students. BackgroundAfter the outbreak of COVID-19, great changes have taken place in the medical education environment, many offline teaching and academic activities have been replaced by online activities. Students’ learning engagement influences the efficiency of online learning. However, the mediating effect of self-regulated learning (SRL) ability between medical education environment perception and learning engagement is unclear. DesignThis study involved a cross-sectional descriptive correlational research. MethodsA total of 228 undergraduatenursing students who were attending online learning were included in this study.This investigation adopted Dundee Ready Educational Environment Measure scale (DREEM), Motivated Strategies for Learning Questionnaire (MSLQ) and Utrecht Work Engagement Scale-Student scale (UWES-S) to respectively know about the levels of medical education environment perception, self-regulating and learning engagement. The structural equation model and bootstrap method were used to clarify the association and interaction among the three variables. ResultsThe scores of nursing students' medical education environment perception, SRL ability and learning engagement were 135.64 ± 15.12, 161.39 ± 22.57 and 68.01 ± 11.77, respectively. Perception of medical education environment directly affects learning engagement (β = 0.556, P < 0.001). SRL ability partially mediated the effect of medical environment perception on learning engagement (x2/df = 1.427, RMSEA = 0.043, GFI = 0.962, NFI = 0.954, TLI = 0.980, CFI = 0.986), and the variance was 30.8 %. ConclusionSRL ability plays a mediating role between medical education environment perception and learning engagement. Nursing educators should continuously optimize the online education environment, such as designing intelligent teaching platform or software, adopting interactive teaching methods, strengthening professional value education and encouraging peer learning, so as to meet the requirements of nursing students' learning engagement in the new medical education environment.

Development and validation of Digi-MEE Instrument measuring online learning environments in medical education

Objectives: To develop and validate Digital Medical Education Environment (Digi-MEE) Instrument for measuring online learning environment in medical education.&#x0D; Methods: This series of studies involved 696 participants from May 2022 to December 2022. Following scoping review, invited modified e-Delphi experts developed consensus on the components and related items for measuring online learning environments. A panel of content experts and a group of medical students carried out content and response-process validation to determine Content Validity Index (CVI) and Face Validity Index (FVI) respectively. This was followed by exploratory and confirmatory factor analysis and reliability analysis to determine Digi-MEE’s factorial structure and internal consistency using SPSS version 26.0 and AMOS 26.0.&#x0D; Results: Delphi experts agreed upon nine components with 73 items of initial Digi-MEE version. CVI of Digi-MEE 2.0 was more than 0.90. with FVI of Digi-MEE 3.0 of 0.87. Exploratory factor analysis yielded 46 items with 57.18% variance. Confirmatory factor analysis led to the final Digi-MEE version containing 28 items within nine components with acceptable levels of goodness of fit indices. Overall Cronbach alpha of the final Digi-MEE was more than 0.90, and for the nine components ranged between 0.62 and 0.76.&#x0D; Conclusion: Digi-MEE is a promising valid and reliable instrument to evaluate online education environment in medical education. Content, response-process, factorial structure, and internal consistency evidence support the validity of Digi-MEE. Medical schools can use Digi-MEE as an evaluation tool for the continuous quality improvement of online learning environments.&#x0D; doi: https://doi.org/10.12669/pjms.39.6.8430&#x0D; How to cite this: Naeem NK, Hadie SNH, Ismail IM, Yusoff MSB. Development and validation of Digi-MEE Instrument measuring online learning environments in medical education. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.8430&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Strategies to Create a More Gender Identity Inclusive Learning Environment in Preclinical and Clinical Medical Education.

Recognition of the spectrum of gender identities has been a recent phenomenon in the medical profession. Over the past 20 years, medical literature related to gender identity diversity has increased several-fold, yet it more commonly addresses clinical care rather than aspects related to medical education. Medical educators continue to struggle with appropriate language and inclusive approaches when discussing gender-based aspects of medical education. Reproductive health education, including obstetrics and gynecology clerkships, is particularly vulnerable to missteps and anachronisms regarding gender identity.This article aims to provide preclinical and clinical medical educators with strategies to identify and predict situations where missteps related to gender identity inclusivity may occur in their curriculum or learning environment, and to develop approaches to improve gender identity inclusivity within medical education. The authors explore 3 areas that commonly pose challenges for medical educators: inclusive language and terminology, anatomy education, and reproductive genetics and genetic counseling. They hope the tools and strategies provided here will be useful to reproductive health medical educators across specialties to enable the realization of a more inclusive learning environment in reproductive health.

Validity Evidence of A Screening Tool for Early Detection of Clinical Crisis-Related Anxiety Amongst Medical Students

Construct: Psychological distress among students is a growing concern in medical education, even more so with the advent of COVID-19 pandemic. Anxiety is among students’ mental health issues. High and persistent anxiety has many negative impacts on students’ academic and personal life. Early detection is essential for timely intervention. Background: Currently, medical student anxiety is assessed using tools primarily designed for psychiatric purposes. Despite their excellent validity evidence, these tools contain sensitive items and do not explore stressors related to clinical activities. There is a need for contextualized tools to better identify anxiety-provoking factors specific to the medical education environment. Approach: We previously developed the Crisis Experience Rating Scale (CERS-7), a short screening tool to identify early on anxious students participating in clinical activities during the first wave of the COVID-19 pandemic. The present study sought to produce further validity evidence for the CERS-7. Medical students in their clinical years at two Swiss and one French medical school, all involved in COVID-19 clinical activity during the second wave of the pandemic, completed the CERS-7 and the State Anxiety Inventory (STAI-A), the best known and widely used tool to measure for general anxiety. We evaluated internal structure using confirmatory factor analysis (CFA) and relation to other variables using linear regression (LR) and receiver operating characteristic (ROC) curves with thresholds defined using the Youden index. Findings: There were 372 participants. CFA confirmed the two-factor structure of the CERS-7 scale from first-wave dataset. The CERS-7 total scale and subscales demonstrated validity evidence in relationship to the STAI-A scores and categories. A CERS-7 total scale score < 27.5 identified 93% of severely anxious students. Conclusion: The CERS-7 produces reliable scores to use for monitoring anxiety status when assigning students to clinical settings as well as for improving training conditions during clinical crisis.

Novel 3D Custom-Made Silicone Tumor Model as a Support for Teaching Surgical Oncology Principles.

Alternative laboratory teaching methods are becoming increasingly desirable and effective in medical education environments. While ethical concerns associated with the use of live animals in terminal surgery laboratories have been reduced with cadaveric models, availability, and lack of pathology can limit their ability to adequately convey surgical principles and replicate clinical training. We have developed a three-dimensional (3D) custom-made silicone soft tissue tumor model using 3D-printed molds derived from canine soft tissue sarcoma computed tomography images. This novel teaching model allows users to apply surgical oncology principles and perform basic technical tasks such as incisional biopsy, margin demarcation, marginal and wide surgical excision, and inking of surgical margins. A large cohort of students in addition to a small number of professional veterinarians at different levels of specialty training followed the laboratory guidelines and evaluated the simulated tumor model based on a qualitative survey. All participants were able to successfully complete the practical training. The model also allowed the students to identify and correct technical errors associated with biopsy sampling and margin dissection, and to understand the clinical impacts related to those errors. Face and content validity of the model were assessed using Likert-style questionnaires with overall average instructors' scores of 3.8/5 and 4.6/5, respectively. Content validity assessment of the model by the students approximated instructors' evaluation with an overall average score of 4.4/5. This model development emphasizes the efficacy of alternative non-cadaveric laboratory teaching tools and could become a valuable aid in the veterinary curricula.

Intelligent Avatars, Holographic Tools, Digitized Objects: An Extended Reality Simulation Demonstration

How can we design engaging and effective medical education both online and on site? Extended reality (XR) is a term referring to all real-and-virtual combined environments and human-machine interactions generated by computer technology and wearables. It includes representative forms such as AR, VR, and MR, and the areas interpolated among them. MR is a domain of particular interest today: It takes place not only in the physical world or in the virtual world, but is a mix of the real and the virtual. Metaverses can be enabled by MR wearable augments. Glasses-free MR is another very interesting dimension: e-REALâ, as a MR environment for hybrid simulation and medical education in general, can be a stand-alone solution or even networked between multiple places through a link to a special videoconferencing system. Digital humans and human-sized holograms are part of the e-REAL scenarios, making this solution unique, rich, and diversified.

Developing a Conceptual Model of Self-Directed Learning in Virtual Environments for Medical Sciences Students

Identification of key factors affecting the self-directed learning process in the virtual environment of medical education is vital. In this article, we designed a model that describes the self-directed learning process in the virtual learning environment for post graduate students of medical sciences in Iran. This study was carried out in two steps: first, using a qualitative study, we explored the formation of a self-directed learning process in the virtual environment. Second, a review of the literature was conducted to identify the conceptual models. Finally, based on the results, a self-directed learning model for virtual learning was developed. A total of 25 people were research participants in the qualitative part, and individual interviews were conducted with both faculty members and students. There were 1,049 codes, 80 subcategories, 15 categories, and 5 themes extracted from the interviews and through analysis. The themes included (a) backgrounds and requirements, (b) support, discipline, and coordination of the educational system, (c) students’ effort to manage to learn, (d) efficiency, attractiveness, and organization of educational environments and context, and (e) personal excellence, growth, and development. The self-directed learning process in virtual environments consists of some elements and structures, and a description of the relationship between these elements can be the basis of educational planning to develop and compile an effective evaluation of this skill.

The “Intern” Label: Introducing Unnecessary Confusion and Bias?

The Oxford English Dictionary defines "intern" as "a student or trainee who works, sometimes without pay, at a trade or occupation in order to gain work experience." In the medical realm, the label "intern" may introduce confusion as well as implicit and explicit bias. In this study, we sought to examine the general public's perception of the label "intern" compared to the more accurate label "first-year resident." We developed 2 forms of a 9-item survey that assessed an individual's level of comfort with surgical trainees' participation in various aspects of surgical care and knowledge of medical education and work environment. One form used the label "intern" and the other used "first-year resident." San Antonio, TX. A total of 148 adults in the general population at 3 local parks on 3 separate occasions. A total of 148 individuals completed the survey (74 per form). Respondents who did not work in the medical field reported less comfort with interns vs first-year residents participating in various aspects of their care. Only 36% of respondents were able to correctly identify which surgical team members have completed a medical degree. Directly assessing perceptual incongruity between the labels "intern" and "first-year resident," 43% of respondents said interns have a medical degree compared to 59% for first-year residents (p = 0.008), 88% stated that interns work full-time in the hospital compared to 100% for first-year residents (p = 0.041), and 82% stated that interns get paid for their work in the hospital compared to 97% for first-year residents (p = 0.047). The label "intern" may confuse patients, family members, and perhaps other healthcare professionals regarding the level of experience and knowledge of first-year residents. We advocate for abolishing the term "intern" and replacing it with "first-year resident" or simply "resident."

Valoración del instrumento modificado Dundee Ready Educational Environment Measure, versión peruana, durante la pandemia COVID-19

IntroductionTo validate a modification of the Peruvian version of the Dundee Ready Educational Environment Measure (DREEM) instrument to assess the distance learning environment during the COVID-19 pandemic. MethodsInstrumental, analytical, cross-sectional, prospective study. A 50-item Google Forms questionnaire was applied to 527 medical students with modifications in the domain of perception of teaching (02) and perception of the atmosphere of the educational environment (03). The sampling was non-probabilistic and by convenience. ResultsThe average age of the students was 20.4 (±2.74) years. 63% were women, 88% used a personal computer and 62.6% described the quality of their Internet connection as regular. The adequacy of the sample was pertinent (Kaiser-Meyer-Olkin sampling coefficient 0.96 and Bartlett's sphericity test with Chi-square 13,976.1; p < 0.05 and df 1,225). The extraction of factors through the analysis of the main components and Varimax rotation, yielded 10 primary factors that explain the accumulated 62.54% of the total variance. The reliability analysis had Cronbach's alpha of 0.95. This result is considered to be very adequate. The students rated the remote educational environment "with many problems", the mean global score was 87.7 (±1.18), with a confidence interval of 95% (85.4 - 89.9), range 134 between 24 and 158 points. ConclusionThe proposal to modify the DREEM instrument of the Peruvian version to assess the remote or distance educational environment in medical education is adequate during the COVID-19 pandemic.

Understanding the Functional Components of Technology-Enhanced Learning Environment in Medical Education: A Scoping Review.

The online version contains supplementary material available at 10.1007/s40670-023-01747-6.

Fostering a Health-Promoting Learning Environment in Medical Education: Adapting the Okanagan Charter for Administrators and Medical Educators.

Medical students enter medical school with similar or even better well-being than their age-matched peers in other educational programs, but there is predictable erosion of their well-being following matriculation. Interventions to counter this erosion predominantly focus on the individual level; however, significant systemic issues persist that thwart meaningful change. Effectively reforming the learning environment and more broadly targeting problematic aspects of the culture of medical education are essential steps to advance efforts to improve medical learner well-being. Although a healthy environment may allow learners to be well in the educational setting, a health-promoting learning environment strives to promote and embed well-being across all aspects of the learner's experience. Health-promoting learning environments operate by infusing health principles into all aspects of operations, practices, mandates, and businesses. The Okanagan Charter is a widely adopted international framework with principles for best practices of adoption. This charter has the recent endorsement of the Association of Faculties of Medicine of Canada, representing all faculties of medicine in Canada, and serves as a framework for reassessing work on well-being in medical education. In response to this endorsement, the authors have adapted the 5 strategies from the charter for pragmatic integration into the medical education environment and added a sixth strategy: (1) embed health in all policies; (2) develop sustainable, supportive spaces; (3) create thriving medical communities and culture; (4) encourage, support, and sustain meaningful personal development; (5) review, develop, and strengthen faculty-level health services; and (6) collaborate and invest in continuous improvement and evaluation. For each of these 6 strategic directions, actionable steps for implementation in academic medicine are provided to create sustainable and meaningful change.

Perceived Workplace Bullying and Mental Health Status among Medical Residents in Iran

Background: The prevalence of negative act behaviors among medical residents has not yet been assessed in our country. Present study aimed at evaluating the prevalence and impact of negative act behaviors among residents of four academic hospitals in Iran.&#x0D; Methods: This cross-sectional survey was conducted on medical residents in two educational hospitals affiliated to Iran University of Medical Sciences. An online electronic questionnaire was distributed to all clinical residents in these hospitals via WhatsApp. We used an online electronic four-part questionnaire including demographic data, Negative Act Questionnaire-Revised (NAQ-R), some questions on negative behaviors causes and effects, and General Health Questionnaire 12 (GHQ-12).&#x0D; Results: In total, 254 completed questionnaires were received, with an overall response rate of 71%. Ninety five percent of participants had experienced negative act behaviors once or more during the last six months, whereas 91% of responders had witnessed negative act behaviors during this time. The most common source of these behaviors were senior residents (73.8% of those bullied, n=178). There was a significant positive correlation between the GHQ score and the NAQ-R score assays.&#x0D; Conclusion: This study, as the first study on the prevalence of bullying and negative acts in Iranian medical residents, showed that the medical education atmosphere in residency is not optimal. Therefore, there is a need for certain interventions in the medical education environment. We recommend better education of residents and faculty members, strong policy making, situation assessment and feedback regulations as essential steps towards diminishing bullying and negative behaviors in resident training centers.