Medical Condition Regard Scale Research Articles

Primary healthcare professionals’ attitudes toward patients with current or previous drug use

Objective People with current or previous drug use (PCPDU) often lack long-term healthcare contacts in primary healthcare (PHC). While international research has shown negative attitudes toward PCPDU in healthcare, PHC professionals’ attitudes toward PCPDU have not been assessed in Sweden. The aim of this study was to investigate PHC professionals’ attitudes to PCPDU, and to compare attitudes toward people who actively use illicit drugs with those toward patients in opioid assisted treatment (OAT). Design In this survey study, respondents were asked for background data, and their attitudes toward patients using illicit drugs, OAT patients and patients with depression were assessed by using an adapted version of the Medical Condition Regard Scale (MCRS). Setting and subjects Nurses and physicians at primary healthcare centers (PHCCs) in Skåne, Sweden. Main outcome measures Mean MCRS scores, dichotomized responses to MCRS items, and associations between MCRS score and background covariates (age, sex, profession and duration of professional experience). Results Eighty-nine PHC professionals from 13 PHCCs responded (approximately 39% of relevant workforce). The median MCRS score was 44 for patients with illicit drug use and patients in OAT, and 51 for patients with depression. Drug use and OAT displayed similar minimum, maximum and interquartile range values as well, while scores regarding depression displayed a higher minimum value and smaller spread. No significant associations were found between background covariates and MCRS scores for either drug use or OAT. Conclusions The results indicate widespread negative attitudes to PCPDU, with implications for health equity in the clinic. Further studies are needed to see if the results reflect attitudes in Swedish PHC in general. Key Points People with current or previous drug use (PCPDU) often lack necessary primary healthcare (PHC) and are commonly subject to prejudice. Swedish PHC professionals held more negative attitudes toward PCPDU than toward patients with depression. Attitudes toward patients with active drug use and patients in opioid assisted treatment (OAT) were almost identical. Study findings have potential implications for the health of PCPDU as well as health equity in the clinic. Widespread negative attitudes to PCPDU in our sample indicate the need of larger-scale studies of attitudes toward PCPDU in Swedish PHC.

Medical Student Attitudes Toward Patients With Substance Use Disorder After Experiential Learning on an Addiction Psychiatry Consultation-Liaison Service: A Pilot Study.

Stigma surrounding substance use disorder (SUD) is highly prevalent in health care. Negative attitudes toward patients with SUD have been shown to negatively impact patient care. Addressing SUD stigma in medical students is a promising approach, however, few curricula include experiential learning on addiction psychiatry clinical services. We describe a medical student rotation on an addiction psychiatry clinical service and examine its effect on attitudes toward patients with SUD. Medical students were integrated onto an addiction psychiatry consultation-liaison service serving medically/surgically hospitalized patients with co-occurring SUD and other psychiatric disorders. Students learned and practiced in-person assessment of patients and received instruction on basic principles of psychiatry and evaluation and management of SUD. A targeted anti-stigma curriculum was included. Attitudes toward patients with SUD were measured with the Medical Condition Regard Scale (MCRS) before and after the experience. Each item of the MCRS and an overall composite attitude score were analyzed. Of the 36 students on the clinical rotation, 33 completed the survey. Attitudes showed widespread improvement toward patients with SUD. Mann-Whitney U tests showed significant improvement in most items of the MCRS. Further analysis of composite scores showed an improvement in overall attitudes toward patients with SUD. Inclusion of medical students on an addiction psychiatry consult service as part of the core psychiatry clerkship may hold promise for helping improve student attitudes and decrease stigma toward patients with SUD. Controlled study is needed to compare other clinical experiences and determine specific causative effects.

Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey.

The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers' clinical practices in caring for their patients. The survey also queried providers' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. DERR1-10.2196/47548.

The power of storytelling: Impact of an interprofessional substance use disorder symposium on stigma and bias in health professions students

With nearly 92,000 drug-involved overdose deaths in the United States in 2020, it is critical to enhance health care professions students’ curricula to prepare future clinicians to meet the complex needs of patients with substance use disorders (SUD). This curricular resource describes a half-day, in-person interprofessional SUD symposium using storytelling as a pedagogical approach. Two learning objectives guided the symposium: a) examine biases against people with SUDs through storytelling, reflection, and role-play and b) create solutions to mitigate stigma that people with SUDs face in the healthcare system. Pre-post analysis included comfort level with interacting with persons with SUDs, Medical Condition Regard Scale, Jefferson Scale of Empathy for Health Professions Students, and word-frequency analysis. Open-ended reflection prompts were completed throughout the symposium and at its conclusion. After participating in the symposium, students reported higher levels of comfort in interacting with persons with SUDs and higher levels of regard for patients with SUDs. Qualitative analysis revealed that students gained knowledge, insight, and skills that will inform their future clinical practice. Overall, the symposium content and format was well received by students. Incorporating interprofessional learning using storytelling, multi-perspective discussion, and role-playing may be an effective way to mitigate stigma and bias regarding SUDs in health professions students. Information required to implement the activity is available under required materials, tables, and figures.

Exploration of Psychiatry Residents' Attitudes toward Patients with Substance Use Disorder, Bipolar Disorder and Schizophrenia in Saudi Arabia.

Stigmatizing attitudes of psychiatry professionals toward patients with various mental disorders may negatively impact treatment-seeking behaviors. However, in Saudi Arabia, little is known about psychiatry residents' attitudes toward individuals with a specific disease/disorder. Therefore, the purpose of this study was to assess psychiatry residents' attitudes toward patients with substance use disorder (SUD), bipolar disorder and schizophrenia in Saudi Arabia. Data for this cross-sectional study were collected from psychiatry residents (N = 79) in Saudi Arabia with a structured questionnaire containing sociodemographic and attitude-related variables. The 11-item Medical Condition Regard Scale (MCRS) for individuals with three conditions was used to assess participants' attitudes. A linear regression model was fitted to investigate the association. Based on the MCRS (on a scale of 11 to 66), participants' mean attitude scores were 41.59 (SD: 8.09), 54.53 (SD: 5.90) and 54.20 (SD: 6.60) for SUD, bipolar disorder and schizophrenia, respectively. Adjusted regression analysis demonstrated that senior residents, an age ≥ 27 years and a high confidence level were significantly associated with psychiatry residents' positive attitudes toward patients with the three conditions. Psychiatry residents' attitude scores were relatively lower (i.e., negative attitudes) for patients with SUD than for those with bipolar disorder and schizophrenia. Future longitudinal studies are recommended to explore the factors behind psychiatry residents' negative attitudes toward patients with addictive behaviors and mental illnesses.

Evaluation of Awareness and Attitudes Towards Eating Disorders and the Female Athlete Triad Among Orthopaedic Surgeons

Background: Eating disorders (EDs) and the Female Athlete Triad are prevalent in female athletes and contribute to an increased injury risk. These patients are highly likely to present to orthopaedic surgeons. Therefore, it is important to evaluate surgeon awareness and attitudes towards these conditions. We hypothesized that awareness and attitudes would be poor overall, would improve with education and comfort recognizing symptoms, and would vary by surgeon demographic characteristics. Methods: An anonymous survey was sent via email to Maryland members of the American Academy of Orthopaedic Surgeons and circulated via social media. The survey assessed demographics, awareness, behaviors, and attitudes surrounding EDs and the Female Athlete Triad. Attitudes towards anorexia nervosa (AN) and binge eating disorder (BED) were assessed using a clinically validated scale, the Medical Condition Regard Scale (MCRS). Results: 52 surgeons completed the survey. 69% of surgeons reported being aware of or receiving didactic training on EDs, and 87% reported being aware of or receiving didactic training on the Female Athlete Triad. The mean levels of comfort with recognizing the symptoms of AN, bulimia nervosa (BN), and BED were 3.4 ± 1.1, 3.1 ± 1.1, and 2.9 ± 1.0 out of 5.0, respectively. Receiving didactic training was significantly associated with comfort recognizing the symptoms of AN, BN, and BED (p=0.01 for all), likelihood of screening for eating disorders (p=0.04), and number of components of the Female Athlete Triad identified (p<0.001). Comfort asking patients about behaviors increased with comfort recognizing the symptoms of AN, BN, and BED (p=0.001, p=0.01, and p=0.03, respectively). Likelihood of counseling on risks associated with EDs increased with comfort asking questions about eating behaviors (p=0.004). The average MCRS score for AN was 49.9 ± 10.6 and the average MCRS score for BED was 48.4 ± 10.9. Surgeons who were “extremely comfortable” discussing behaviors had significantly higher MCRS scores for AN and BED than those who were “extremely uncomfortable” (p=0.02 and p=0.01, respectively). Conclusion: The results of this study demonstrated moderate levels of awareness of and attitudes towards patients with EDs and the Female Athlete Triad. Effective management of these patients is grounded in thorough screening and formation of a therapeutic relationship, both of which are shown to relate to targeted didactic training. In order to improve care for patients with EDs and the Female Athlete Triad, didactic training that focuses on improving awareness, comfort, and attitudes should be implemented into orthopaedic surgery educational curricula.

728 A Survey of Health Professionals' Attitudes Regarding Substance Abuse Disorder in Burn Patients

Abstract Introduction Substance abuse disorder (SAD) is complex, involving the continued use of drugs or alcohol despite harmful consequences. The diagnosis of this disorder carries a stigma that can bring shame to the individual, and healthcare providers are not immune to attitudes that worsen this shame. This coupled with patient behaviors can make caring for these patients challenging. We have seen an ever-increasing number of patients admitted to the burn center with this preexisting comorbidity. The purpose of this study was to better understand our own attitudes and potential bias or barriers that may be present in caring for this population. Methods A modified version of the 11-item Medical Condition Regard Scale (MCRS) was distributed to burn center personnel via REDCap. An additional 6 burn specific questions were asked. Participants were asked to respond on a 6-point Likert scale. There were both positively (POS) and negatively (NEG) phrased questions. No personal or professional demographic data was collected to ensure the anonymity of respondents. Results A total of 52 individuals responded to the survey. When responding to POS questions, the majority agreed that insurance coverage should be equal to other conditions (96%), would not mind being called in to care for this population (75%), felt they could find something to help the patient feel better (65%), felt compassion (65%), found working with SAD patients satisfying (65%) and enjoyed giving extra time to these patients (51%). When asked NEG questions, 40% responded it was difficult to work with these patients, 25% reported irritation, 23% preferred not to work with SAD patients, 13% felt there was little they could do to help, and 2% felt it was a waste of medical dollars. When asked POS burn specific questions, the sample was split 50/50 in regard to efficacy of current practice to manage withdrawal symptoms, 92% felt that these patients experienced more anxiety, had other mental health disorders (98%) and that pain management was particularly difficult (98%). When asked NEG burn specific questions 48% felt the care they provided was appreciated, and only 62% felt safe when providing care. Conclusions The majority of staff reported willingness to help these patients yet reported difficulty in working with the population. Staff felt that these patients were more apt to have concurrent mental health disorders and increased anxiety. Management of pain and withdrawal symptoms were identified as areas of care that need improvement. It is concerning that 38% of staff felt unsafe in providing care. Identification of bias and barriers is the first step in an initiative to optimize protocols that will improve patient outcomes and work experiences. Applicability of Research to Practice Protocols specific to the burn population that suffers from concurrent SAD are needed to optimize care.

Humanizing Substance Abuse: A Theory-Based Educational Intervention for Undergraduate Nursing Students.

Healthcare providers, as well as healthcare students, have been found to harbor negative attitudes toward individuals with substance abuse disorders, impacting the care they give and subsequently creating poor patient outcomes. This study seeks to determine the effectiveness of an educational intervention, grounded in theory, toward changing nursing student attitudes regarding patients with a substance abuse disorder. Nursing students participated in a teaching intervention, developed using the experiential learning theory, that utilizes modalities for each kind of learner aimed at reducing bias toward this population. The Medical Condition Regard Scale was used pre/post intervention to determine regard toward patients with the diagnosis of substance abuse. Student nurses maintained the least favorable attitudes toward individuals who abuse substances in comparison with patients with the diagnoses of pneumonia or gastroesophageal reflux disease; there were significant differences in attitudes toward patients who abused substances before and after participation in the educational intervention, with postparticipation attitudes being significantly more positive than attitudes before participation. Students found the educational intervention and debriefing highly satisfactory. This educational intervention can provide a cost-effective, easy-to-replicate, time-efficient learning activity that could be added to undergraduate nursing curriculum.

Attitudes and regard for specific medical conditions among Australian emergency medicine clinicians.

To quantify the attitude ED clinicians hold towards patients presenting with different medical conditions, including a novel pandemic condition. A cross-sectional study of emergency doctors and nurses utilising the Medical Condition Regard Scale (MCRS); a validated tool used to capture the bias and emotions of clinicians towards individual medical conditions. The five conditions presented to participants each represent a classical medical, complex medical, psychiatric/substance use, somatoform and a novel medical condition. One hundred and ninety-six clinicians were included in the study including 116 nurses and 80 doctors. Concerning each condition, both medical and nursing staff demonstrated the highest regard for a classical medical condition (58 ± 5 and 57 ± 6, respectively). Significantly different from the classical medical condition, the lowest MCRS scores were for the somatoform condition (36 ± 10) for emergency doctors and the substance use condition (39 ± 11) for emergency nurses. Regard for a novel condition (i.e., COVID-19 infection) was comparably high among both cohorts. Emergency doctors and nurses generally hold lower regard for complex medical conditions with behavioural components, including substance use disorders and somatoform conditions.

Alignment Between Resident Medical Condition Regard Scale Scores and Desire to Treat Patients With Opioid Use Disorder.

To (1) evaluate attitudes of resident physicians towards patients with opioid use disorder (OUD) and (2) identify characteristics associated with residents' desire to treat patients with OUD. We administered the validated medical condition regard scale (MCRS), a question regarding desire to treat patients with OUD, and a demographic questionnaire to residents in multiple specialties at the University of New Mexico (family medicine, psychiatry, emergency medicine, internal medicine, anesthesiology, general surgery, obstetrics/gynecology). One hundred sixty-three of 307 residents (53%) responded to the survey; 146 provided complete responses to the "desire" and MCRS questions. Response rates, MCRS, and desire to care for patients with OUD varied between specialties ( P < 0.001); family medicine had highest MCRS and desire to care scores; surgery, anesthesiology had low scores. MCRS and resident "desire" scores were highly correlated on univariate analysis ( r = 0.73, P < 0.001); resident demographics were not. On logistic regression, resident desire to care for OUD increased with MCRS scores ( P < 0.001). The predicated probability of desire to care for OUD was ≥80% with MCRS >57; MCRS classification skill on receiver operator curve analysis was excellent (area under curve = 0.81 [95% confidence interval 0.74, 0.88], and specialty-adjusted MCRS area under curve = 0.85 [95% confidence interval 0.79, 0.91]). High resident regard for patients with OUD on MCRS was directly related to resident's desire to provide OUD care. MCRS may offer a tool to alter or individualize OUD education, potentially influencing the OUD workforce of the future.

Screening, brief intervention, and referral to treatment (SBIRT) training reduces stigma and prepares orthopaedic providers to identify and intervene in opioid misuse: a prospective cohort study

Background: Despite the evolution of responsible opioid prescription for musculoskeletal pain, patients remain at risk for opioid problematic use, misuse, and addiction. Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based practice to identify, reduce, and prevent those outcomes. This pilot study investigated the use of SBIRT practices developed to target opioid misuse in the orthopaedic practice environment and its applicability in the orthopaedic population. Methods: In this prospective cohort study, 19 orthopaedic providers underwent SBIRT training. Participants reported on their use of SBIRT over 6 wk and completed the Medical Condition Regard Scale (MCRS). Results: Twelve participants successfully implemented SBIRT, screening an average of 58.5% of patients. Seventeen percent of patients screened to an elevated risk level. Patients who screened as medium or high risk were 5.8 and 8.4 times more likely, respectively, to receive intervention compared with patients who screened to low risk or not screened (P&lt;0.01). Regard for patients with opioid use for pain increased from an MCRS score of 44.6 to 52.5 (P&lt;0.01). Ninety-five percent of participants found the training useful, and 89% would recommend the training to a colleague. Conclusions: This study demonstrated integration of SBIRT practices into an orthopaedic environment in which a significant proportion of orthopaedic patients screened to elevated risk of opioid misuse and qualified for brief intervention by the orthopaedic provider. SBIRT training had a positive impact on opioid-use stigma, a recognized barrier to care. Further study is warranted to determine the effect on patient outcomes and optimal implementation strategy. Level of Evidence: Level II.

Demonstrating the Efficacy of Incorporating Peers Into Addiction Training for Internal Medicine Residents.

Objective: Although internists frequently care for patients with substance use disorders (SUDs), they do not receive training that is adequate for the task. The resultant deficiencies in care are compounded by widespread stigma toward SUDs that exists within medicine. However, research demonstrates that sharing personal perspectives and experiences of living with an SUD generate empathy and change attitudes toward this disorder. The objective of this study was to improve internal medicine residents' attitudes with an educational seminar that incorporates perspectives from patients with SUDs and their families.Methods: The study was conducted with internal medicine residents at Weill Cornell Medical College from February 2019 to August 2019. The study used a cross-sectional, longitudinal survey design. Attitudes were measured using a validated Medical Condition Regard Scale (MCRS).Results: A total of 31 internal medicine residents participated. Results showed significant increases in MCRS scores, both from pre- to post-seminar and 6 months after the seminar. For alcohol use disorder, mean (SD) MCRS score increased from 3.80 (SD = 0.69) to 4.60 (SD = 0.87) to 5.00 (SD = 0.68) (P < .001). For opioid use disorder, mean MCRS score increased from 3.30 (SD = 0.92) to 4.36 (SD = 0.99) to 4.62 (SD = 0.70) (P < .001).Conclusion: The study demonstrates that long-term attitudes toward patients with SUDs may be modified through training that integrates peer-based perspectives.

The effects of screening brief intervention referral to treatment (SBIRT) training on health professional trainees’ regard, attitudes, and beliefs toward patients who use substances

Background: Screening Brief Intervention Referral to Treatment (SBIRT) was developed as an integrated and comprehensive public health approach that includes early screening and intervention to address substance use in a variety of health care settings. Research suggests that SBIRT is effective in reducing substance use in individuals whose use places them at higher risk for negative health and social consequences. However, less is known about how training in SBIRT modifies attitudes, regard, and beliefs toward people who use substances. Methods: Participants included 461 students from a variety of healthcare related disciplines (physician assistant, nurse practitioner, pharmacy, psychiatry and psychology, and medical students). Participants were evaluated using a pre-post design to assess changes in regard, attitudes, and beliefs by completing the Short Alcohol and Alcohol Problems Perception Questionnaire, the Drug Problem Perception Questionnaire, the Medical Condition Regard Scale, and the Short Understanding of Substance Abuse Scale before and after a 7-hour SBIRT training program. We hypothesized that trainees would have more positive regard, attitudes, and beliefs toward people who use substances following training in SBIRT relative to a baseline assessment and that there would be between program differences. Results: Results were consistent with hypotheses and suggested that trainees had significantly more positive regard and changes in attitudes and beliefs toward working with patients who use substances following training in SBIRT. Results also suggested significant differences by training group at baseline and at 30-day follow up. Conclusions: Overall, the findings suggest that an important additional benefit of SBIRT is the impact it has on mitigating healthcare professional trainees’ negative regard and modifying attitudes and beliefs toward those who use substances.

A comparative study of the effect of the Time for Dementia programme on medical students.

ABSTRACTBackgroundTraditional healthcare education typically focuses on short block clinical placements based on acute care, investigations and technical aspects of diagnosis and treatment. It may therefore fail to build the understanding, compassion and person‐centred empathy needed to help those with long‐term conditions, like dementia. Time for Dementia was developed to address this.MethodParallel group comparison of two cohorts of UK medical students from universities, one participating in Time for Dementia (intervention group) and one not (control group). In Time for Dementia students visit a person with dementia and their family in pairs for 2 hours three times a year for 2 years, the control group received their normal curriculum.ResultsIn an adjusted multilevel model (intervention group n = 274, control n = 112), there was strong evidence supporting improvements for Time for Dementia participants in: total Approaches to Dementia Questionnaire score (coefficient: 2.19, p = 0.003) and its person‐centredness subscale (1.32, p = 0.006) and weaker evidence in its hopefulness subscale (0.78, p = 0.070). There was also strong evidence of improvement in the Dementia Knowledge Questionnaire (1.63, p < 0.001) and Dementia Attitudes Scale (total score: 6.55, p < 0.001; social comfort subscale: 4.15, p < 0.001; dementia knowledge subscale: 3.38, p = 0.001) scores. No differences were observed on the Alzheimer's Disease Knowledge Scale, the Medical Condition Regard Scale or the Jefferson Scale of Empathy.DiscussionTime for Dementia may help improve the attitudes of medical students towards dementia promoting a person‐centred approach and increasing social comfort. Such patient‐focused programmes may be a useful complement to traditional medical education.

Include-integrate-involve: Deciphering oral healthcare providers’ professional demeanor towards sexual and gender minority cohorts in a metropolitan city of western India

ObjectivesThe Sexual and Gender Minorities (SGM) have been subject to disparities in healthcare. This study gauges and compares the demeanor of oral health task force in privately-funded and government-funded dental schools of India towards SGM cohorts. Study designA descriptive, cross-sectional, point prevalent study was conducted following standard statements of the STROBE guidelines and using the Medical Condition Regard Scale (MCRS). It was conducted among the clinical oral health taskforce hailing from private-funded and government-funded institutes. MethodsOne-way ANOVA test computed differences in mean MCRS scores among the undergraduates, postgraduates and faculty. Independent t-test compared responses of participants from private institutions and government institutions using SPSS version 17 statistical software. ResultsAll the respondents were mostly but not completely satisfied to work with SGM patients (MCRS score ​= ​4.55 ​± ​1.114) indicative of some underlying hesitance. Though everyone had a positive regard, undergraduates and those from private institutions felt more compassionate and showed greater willingness to put in extra efforts to help them feel at ease (P-value <0.05). This is interpretive of more receptiveness towards specialized training and policy reforms of these individuals. ConclusionThe significant differences between institutes and designations highlight disparities in knowledge and training resulting in the underlying hesitation. Health education urgently needs a targeted and focused SGM-related training program to deconstruct these disparities and provide equitable oral and general health for all individuals irrespective of their sexual orientation.

An exploration of medical student attitudes towards older persons and frailty during undergraduate training.

Older persons and patients with frailty constitute an ever increasing proportion of hospital patients. Improving student attitudes towards both groups is important in preparing future doctors for this demographic shift. We aimed to investigate medical student attitudes towards older persons and frailty over an entire medical school cohort. All current Brighton and Sussex Medical School students were invited to complete an online questionnaire consisting: (i) the Australian Ageing Semantic Differential (AASD), (ii) the Medical Condition Regard Scale (MCRS) with regards to frailty, (iii) a qualitative question asking participants to record three words regarding both a person over 70years and frailty. 187 students participated (66% female, 25.2% response rate). Participants reported positive attitudes with mean scores of 73.45/114 on the AASD and 52.4/66 on the MCRS. The most positive attitudes towards both older persons and frailty were held by year 1 students, and most negative by year 3 and year 4 students for older persons and frailty, respectively. Examining AASD subgroups, students held negative attitudes towards the instrumentality (function) of older persons (mean score: 17.6/36) with significant variation across year groups (p < 0.05), with the most negative attitudes expressed in year 3. Word clouds of qualitative responses showed that medical students consider the two concepts differently with frailty attracting more negative associations. Generally medical student attitudes were positive towards older persons and frailty. However, these declined when focusing on the functionality, with word cloud analysis of attitudes revealing a dichotomy between the quantitative and qualitative data surrounding frailty.

Burnout and attitudes toward deliberate self harm amongst UK junior doctors

ABSTRACT Deliberate self-harm (DSH) is a major global health problem and a significant risk factor for death by suicide. Despite this, those who suffer are often confronted with negative attitudes from healthcare professionals whilst seeking help, with detrimental consequences for treatment outcomes. While several factors may affect attitudes to DSH amongst healthcare professionals, there is now growing evidence to suggest an association with burnout. As current levels of burnout amongst junior doctors are estimated to be high, understanding the nature of this association is crucial. The over-arching aim of this project is therefore to explore junior doctors’ attitudes toward DSH in comparison with other presenting conditions and to explore any possible relationship these may have with features of burnout. We conducted an online cross-sectional survey of junior doctors working within NHS Greater Glasgow and Clyde. After collecting sociodemographic information, participants were presented with both the abbreviated Maslach Burnout Inventory and the Medical Condition Regard Scale for patients presenting with; Chronic Obstructive Pulmonary Disease (COPD), Type I Diabetes Mellitus (T1DM), Schizophrenia and DSH. Significant differences in attitudes according to presenting complaints/conditions were identified. Participants reported the highest regard for TIDM and lowest regard for DSH, varying as a function of speciality and years of NHS service. 21% of participants were experiencing ‘burnout’ to a high degree, and scores also varied as a function of speciality and years of NHS service. No association between burnout and attitudes were observed for any of the investigated diagnoses. Our findings highlight the desperate need for evidence-based interventions to address burnout and negative attitudes toward DSH amongst junior doctors. Moreover, they may suggest that these attitudes worsen through the course of junior doctor training. We would therefore advocate for further research to assess the efficacy of interventions designed to address this.

Changes of Students’ Attitude towards Patients with Chronic Conditions during Medical Education: Comparing Addiction, Dementia, and Diabetes

Medical students’ attitudes towards patients with addiction and towards other chronic conditions might be comparable. Positive attitudes towards such conditions can be developed during medical education. This study evaluated medical students’ attitudes towards patients with addiction, dementia, and diabetes, and how such attitudes change during training. This is an observational prospective cohort study. Participants (N = 100) were students who recruited from Primary and Community Care training, which consisted of theoretical courses and a clinical rotation. The Medical Condition Regard Scale was used to measure the attitudes and a repeated-measures analysis was performed to compare them. Before training, students’ attitudes towards patients with addiction were more negative than towards dementia and diabetes. The attitudes towards addiction remained stable during the entire training, whereas the attitudes towards dementia and diabetes remained stable during the theoretical courses but decreased after the clinical rotation. These findings emphasize a need to pay attention to students’ attitude development towards patients with chronic diseases, addiction in particular, during medical training.

Paramedic student empathetic attitudes towards homelessness: a mixed methods pilot study

PurposeCurrent statistics highlight the increasing prevalence of homelessness in Australia, however, there is scant research regarding empathy and homelessness in the paramedic literature. Research in other areas of healthcare demonstrates that interaction with the homeless can positively impact empathetic attitudes and also highlights the opportunity to examine if these results are consistent or generalisable to the Australian paramedic profession. Therefore, the aim of our study was to explore paramedic students' empathetic attitudes towards homelessness.Design/methodology/approachA sequential mixed method design study was undertaken using a repeated measures and focus group approach. Paramedic students participated in clinical experience, involving interactions with the homeless. This entailed participating in at least four shifts (11 pm – 5 am) where students gained experience at the Salvation Army Health Café or with the Youth Street Teams in Melbourne, Australia. Empathy levels of the paramedic students toward homelessness, both pre- and post- were measured using the Medical Condition Regard Scale (MCRS) and the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI). A focus group with student participants was also conducted to obtain further detailed information about their perceptions of the experience.FindingsA total of 20 students participated (100% response rate). Statistically significant (p < 0.05) increases were observed on the MCRS pre- to post- data with total mean scores of 48.35 (SD ± 8.33) and 51.65 (SD ± 5.56), respectively. On the HPATHI a statistically significant (p < 0.0001) increase in Personal Advocacy was observed. Eight of these students took part in a subsequent focus group. Following thematic analysis of the focus group, a number of common themes were identified that included: communication, empathy and rapport, and a change in perception and attitude.Originality/valueThe results of this pilot study demonstrate that through participation in a project involving experience interacting with the homeless population, paramedic students showed a greater level of empathy towards the homeless. Increases in empathetic regard, social advocacy and personal advocacy were also found.

Evaluation of competency and willingness of junior residents to provide oral care for people living with HIV and AIDS in satellite treatment centers

Objectives: Oral health care to people living with HIV/AIDS (PLWHA) is usually neglected due to the social stigma and the fear of cross infection. Hence, this study aimed to assess the knowledge regarding HIV/AIDS and the attitude of junior residents in providing oral care to PLWHA. Materials and Methods: A cross-sectional questionnaire was administered to 96 junior dental residents in our institute, who were providing oral care at peripheral dental centers. Subjects answered a question “will you be willing to provide oral care on your free will if you knew the patient has HIV/AIDS” either “yes” or “no;” followed by questionnaire assessing knowledge on HIV/AIDS, and its oral manifestations and Medical Condition Regard Scale were used for assessing the attitude of residents. Results: Of the 96, only four reported to treat HIV/AIDS patients willingly; only 2% of residents have ever treated HIV/AIDS patients. More than 70% of them did not know the protocol in case of needle prick or blood splatter and post-exposure prophylaxis. However, the knowledge regarding oral manifestation of HIV/AIDS was satisfactory. The attitude of the residents was more negative (median=3.02) toward treating HIV/AIDS patients. Conclusion: Knowledge regarding post-exposure protocol was poor and it is high time that special care dentistry is included as part of the dental curriculum to increase awareness and knowledge regarding HIV/AIDS; and we do recommend compulsory postings for junior residents in tertiary hospitals to alleviate the fear, discrimination, and stigmatizing attitude toward HIV/AIDS.