Zealand Medical Students Research Articles

Support of parenting in undergraduate medical training in New Zealand

Purpose This research assessed support for parents studying undergraduate medicine at a New Zealand medical school and identified requirements for additional support. Method Support documentation was sourced from Student Affairs and university and medical school websites. The Medical Deans of Australia and New Zealand Medical Students Outcome and Longitudinal tracking Project was retrospectively examined for data specific to medical student parents. Student parents and medical school staff were also surveyed for their knowledge and perceptions around organisation and effectiveness of available support, and suggestions for additional support. Results Parents and expectant parents formed a consistent, likely growing sub-group studying medicine from 2008 to 2020, yet no formal student parent support policy existed until 2019. Prior to this, 67% of student parents and 47% of staff lacked knowledge of available support. Since 2020, calls for greater visibility of parenting policies and flexibility in the curriculum have been operationalised by the medical school. Conclusion Formalising policies and procedures, maximising access to parenting support resources and introducing flexibility in medical curricula can help students balancing families and medical training. This is relevant for sustainability of medicine as a career option for medical students wanting children, especially considering over half of all medical students are female.

Implementation of An Interactive Radiation Oncology Clinical Rotation for Medical Students

Background Our radiotherapy department is situated onsite at a university-affiliated hospital where medical students undertake clinical rotations. However, no formal programme for attachments to the radiation oncology service was previously in place. Student experience was limited to occasional classroom-based lectures and sporadic contact with cancer patients while rotating through other clinical services. Under-exposure to radiation oncology (RO) (and oncology generally) during medical school is common. A 2016 survey of medical students at two US universities found that only 4% of third year and 7% of fourth year students completed an RO rotation (Osvarak et al 2016). And 47% of Australian and New Zealand medical students recently reported that RO was not incorporated into their curriculum at all (Bravery et al 2020). We identified improving medical student involvement as a priority for our department. Methods We collaborated with tutors at the University to arrange for medical students to have allocated RO rotations during their clinical attachments at the hospital. Agreed learning objectives fitted into three categories: -fundamental clinical skills in history taking and physical examination -care of cancer patients -an introduction to RO and its role in the care of cancer patients. A multidisciplinary effort with involvement of consultant and trainee radiation oncologists, radiation therapists, nurses, and university representatives allowed us to develop a programme to deliver these learning objectives. Results The programme began in January 2022. One radiation oncologist takes overall responsibility for day-to-day operations and acts as the primary point of contact for the students and other staff members in case of any issues. Students receive tutorials on oncological emergencies and are involved in academic sessions in the department. They are supervised as they spend time contouring organs at risk and clinical targets and also have dedicated sessions with radiation therapists where they observe the delivery of external beam radiotherapy. Clinical experience is gained via attendance at outpatient clinics and on the inpatient oncology ward. Feedback on history taking and clinical examination is provided via tutorials with radiation oncologists and trainees. Students provided feedback which indicated that they had enjoyed their experience of the specialty and found the rotation beneficial. Discussion The rotation has been well-received by students and the university tutors. The primary goal of incorporating RO rotations into the medical school curriculum was successful and these attachments will continue in future. Involvement of relevant stakeholders within the department and the university contributed to the successful implantation. Our radiotherapy department is situated onsite at a university-affiliated hospital where medical students undertake clinical rotations. However, no formal programme for attachments to the radiation oncology service was previously in place. Student experience was limited to occasional classroom-based lectures and sporadic contact with cancer patients while rotating through other clinical services. Under-exposure to radiation oncology (RO) (and oncology generally) during medical school is common. A 2016 survey of medical students at two US universities found that only 4% of third year and 7% of fourth year students completed an RO rotation (Osvarak et al 2016). And 47% of Australian and New Zealand medical students recently reported that RO was not incorporated into their curriculum at all (Bravery et al 2020). We identified improving medical student involvement as a priority for our department. We collaborated with tutors at the University to arrange for medical students to have allocated RO rotations during their clinical attachments at the hospital. Agreed learning objectives fitted into three categories: -fundamental clinical skills in history taking and physical examination -care of cancer patients -an introduction to RO and its role in the care of cancer patients. A multidisciplinary effort with involvement of consultant and trainee radiation oncologists, radiation therapists, nurses, and university representatives allowed us to develop a programme to deliver these learning objectives. The programme began in January 2022. One radiation oncologist takes overall responsibility for day-to-day operations and acts as the primary point of contact for the students and other staff members in case of any issues. Students receive tutorials on oncological emergencies and are involved in academic sessions in the department. They are supervised as they spend time contouring organs at risk and clinical targets and also have dedicated sessions with radiation therapists where they observe the delivery of external beam radiotherapy. Clinical experience is gained via attendance at outpatient clinics and on the inpatient oncology ward. Feedback on history taking and clinical examination is provided via tutorials with radiation oncologists and trainees. Students provided feedback which indicated that they had enjoyed their experience of the specialty and found the rotation beneficial. The rotation has been well-received by students and the university tutors. The primary goal of incorporating RO rotations into the medical school curriculum was successful and these attachments will continue in future. Involvement of relevant stakeholders within the department and the university contributed to the successful implantation.

Trends in medical students' health over 5 years: Does a wellbeing curriculum make a difference?

Trends in New Zealand (NZ) medical students' health and the influence of a wellbeing curricula are unknown. The author's collected self-report data from NZ medical students on 'Graduation Day' from 2014 to 2018, using a serial cross-sectional survey design with validated scales assessing psychological health, stigma, coping, and lifestyle. Comparisons were made with NZ general population same-age peers. Analyses examined trends, differences between 'cohorts' of students receiving different exposures to a wellbeing curriculum, and correlations between students' own lifestyle practices and their frequency of talking with patients about those topics. Of 1,062 students, 886 participated. The authors found statistically significant self-reported increases from 2014 to 2018 for negative psychological indices, including scores for distress and burnout, suicidal thoughts in the preceding year, and the likelihood of being diagnosed with an anxiety disorder. There was a significant increase in numbers of students reporting having their own doctor as well as increased healthy coping strategies and a significant decrease in stigma scores. Academic cohorts of students who had completed a wellbeing curriculum were more likely to report high distress levels, having been diagnosed with a mood disorder, and being non-drinkers than students without wellbeing training. When compared to NZ peers, medical students smoked less, exercised more, and were less likely to have diagnosed mood and anxiety disorders, but reported more distress. The authors found a significant correlation between the amount of exercise students undertook and their likelihood to discuss exercise with patients. NZ medical students have better physical health than general population peers and are more likely to discuss exercise with patients if exercising themselves. However, cohorts of graduating students report increasing distress despite the implementation of a wellbeing curriculum. Research is needed into mechanisms between students' self-awareness, willingness to report distress, stigma, mind-set, coping, and psychological outcomes, to inform curriculum developers.

Beyond empathy decline: Do the barriers to compassion change across medical training?

Background: Despite being a mandated, foundational value in healthcare, research on compassion remains limited. Studying the individual, patient, clinical, and contextual factors that interfere with compassion—the “barriers”—may clarify our understanding of the origins of compassion and identify potential targets for improving patient-centred care. Studies of the related construct of empathy have suggested that medical students report declines with increasing clinical experience. In contrast, when comparing physicians with medical students, increased clinical experience predicts lower barriers to compassion. Whether—and how—a similar experience-related decline in the factors that interfere with compassion occurs across medical training remains unknown.Aims: To describe how the barriers to compassion vary across clinical training in medical students.Method: New Zealand medical students (N = 351) in their clinical years (Years 4–6) completed measures of the Barriers to Physician Compassion (BPCQ) and potential covariates such as demographics, work burden factors, and dispositional factors. The BPCQ indexes the extent to which barriers in four domains (individual, patient, clinical, and contextual) interfere with a physician/student’s compassion towards patients. Analyses of variance and regression analyses were used to explore the effect of year level on the four types of barriers.Results: Year 4 students reported slightly lower student-related, environmental and patient/family-related (but not clinical) barriers than Year 6 students (effect size: ɷ2 < 0.05); all barriers increased comparably across training. Controlling for relevant confounds, regression analyses confirmed that lower year level predicted lower barriers to compassion. Higher self-compassion, but not gender, predicted lower barriers.Conclusions: In extending studies of empathy decline, this report suggests that students experience higher barriers to compassion as clinical training progresses. This is in contrast to existing studies contrasting physicians with medical students, where greater experience was associated with lower perceived barriers to compassion. Self-compassion may offset increases in barriers to care.

Global health classroom: mixed methods evaluation of an interinstitutional model for reciprocal global health learning among Samoan and New Zealand medical students

BackgroundGlobal health education partnerships should be collaborative and reciprocal to ensure mutual benefit. Utilisation of digital technologies can overcome geographic boundaries and facilitate collaborative global health learning.Global Health Classroom (GHCR) is a collaborative global health learning model involving medical students from different countries learning about each other’s health systems, cultures, and determinants of health via videoconference. Principles of reciprocity and interinstitutional partnership informed the development of the GHCR. This study explores learning outcomes and experiences in the GHCR between students from New Zealand and Samoa.MethodsThis study used a mixed methods approach employing post-GHCR questionnaires and semi-structured face-to-face interviews to explore self-reported learning and experiences among medical students in the GHCR. The GHCR collaboration studied was between the medical schools at the University of Otago, New Zealand and the National University of Samoa, Samoa.ResultsQuestionnaire response rate was 85% (74/87). Nineteen interviews were conducted among New Zealand and Samoan students. Students reported acquiring the intended learning outcomes relating to patient care, health systems, culture, and determinants of health with regards to their partner country. Interview data was indicative of attitudinal changes in relation to cultural humility and curiosity. Some reported a vision for progress regarding their own health system. Students in the GHCR reported that learning with their international peers in the virtual classroom made learning about global health more real and tangible. The benefits to students from both countries indicated reciprocity.ConclusionsThis study demonstrates GHCR to be a promising model for collaborative and reciprocal global health learning using a student-led format and employing digital technology to create a virtual classroom. The self-reported learning outcomes align favourably with those recommended in the literature. In view of our positive findings, we present GHCR as an adaptable model for equitable, collaborative global health learning between students in internationally partnered institutions.

Applying Rasch analysis to evaluate and enhance the Academic Motivation Scale

ABSTRACT Objective The 28-item Academic Motivation Scale (AMS) is a widely used measure of students’ motivation to learn but it has the common limitations of an ordinal scale such as low precision and unsuitability for parametric statistics. The current study aimed to evaluate the psychometric properties of the AMS using Rasch methodology and enhance the precision of the scale using ordinal-to-interval transformation. Method The Partial Credit Rash model was used to analyze responses of 429 New Zealand medical students who completed the scale in English. Results The initial poor fit of the AMS to the Rasch model was improved by creating four super-items combining dependent subscales/items that displayed higher residual correlations with each other. These modifications resulted in the best fit to the Rasch model with no significant deviations of scale parameters from the model expectations (χ2 (24) = 19.79, p = 0.71), invariance across sex, age and ethnic groups, unidimensionality and high reliability (PSI = 0.81). Conclusions This study supported the robust psychometric properties of the AMS and produced conversion tables to transform the ordinal AMS scores into interval-level data to enhance the precision of the scale and enable use of parametric statistics without altering the original scale structure. KEY POINTS What is already known about this topic: (1) The Academic Motivation Scale (AMS) was developed to measure academic motivation which is important in higher education settings to evaluate students’ motivation to learn. (2) The AMS is an ordinal scale which is not suitable for parametric statistical tests and has other limitations of an ordinal measure, such as low precision. (3) The full-scale AMS is the most reliable according to the recent evidence, while the individual subscales of the AMS have low generalisability across student population and response occasions. What this topic adds: (1) Using Rasch methodology provides a powerful tool to evaluate and enhance the psychometric properties of an ordinal scale such as the AMS. (2) Rasch model fit indicates that the AMS complies with fundamental principles of measurement, such as unidimensionality, invariance, and interval scale metrics. (3) This study produced ordinal-to-interval conversion tables to transform ordinal responses to the AMS into interval level data that increases precision of the instrument and its suitability for parametric statistics

New Zealand medical students\u2019 views of euthanasia/assisted dying across different year levels

BackgroundPrevious studies report a majority of the general public support euthanasia/assisted dying (EAD), while a majority of doctors are opposed. In considering policy decisions about EAD, some may discount the views of doctors because they take them to be based on personal values or tradition, rather than reasons that the general public might share. One way to explore this notion is to examine whether medical students’ views change during their medical education.The objective of this study was to learn how New Zealand medical students view EAD and whether students at different year levels have different views.MethodsAn on-line survey of undergraduate medical students was conducted asking whether they supported a law change to allow EAD. Quantitative data was analysed using unadjusted and multiple logistic regression. Thematic analysis was conducted with the qualitative data.ResultsA total of 326 students replied to the survey. The overall response rate was 28%. 65% of 2nd year students were supportive of EAD, compared to 39% in 5th year. The odds of 5th year students supporting a law change compared to 2nd year was 0.30 (95% CI: 0.15–0.60).The predominant themes found in the qualitative results indicate that medical students support or oppose EAD for reasons similar to those found in the wider debate, and that their views are influenced by a range of factors. However, several at all year levels cited an aspect of medical school as having influenced their views. This was mentioned by participants who were supportive of, opposed to, or unsure about EAD, but it was the type of influence most often mentioned by those who were opposed.ConclusionsThe quantitative findings show students at the end of 5th year were less likely to support EAD than students at the end of 2nd year. We suggest that this difference is most likely due to their time in medical education. This suggests that the lower support found among doctors is in part related to medical education and medical work rather than age, personality, or social context. The qualitative findings indicate that this is not related to a particular educational experience at Otago Medical School but a range.

How does self-perceived nutrition competence change over time during medical training? A prospective longitudinal observational study of New Zealand medical students

ObjectivesMedical nutrition education aims to equip doctors with nutrition knowledge, skills, attitudes and confidence to counsel patients to improve their diet. This study aimed to describe changes in medical students’...

The New Zealand Medical Students’ Association (NZMSA): A year in review 2020

This provides an overview of the activity of the New Zealand Medical Students’ Association (NZMSA) in 2020. It discusses how, like many other things this year, everything has not gone to plan, but despite this NZMSA’s accomplishments and the role the executive has played in 2020.

Can we be doctors and still have a life?

“How can I have a life outside of medical school?” This was a question asked of the Wellness panel at the recent New Zealand Medical Students’ Association (NZMSA) conference. Have you ever felt like this? Have you wondered how you will cope with being a doctor? Dr Samantha King, Medical Adviser for the Medical Protection Society (MPS), discusses work/life balance, wellbeing, and mitigating the risk of burnout.

You are not alone: an interview with the Chief Executive Officer of Chnnl, Dr Liz Berryman

If you have ever felt bullied or embarrassed within the workplace, Liz Berryman gives us hope to be heard. Although there has been a shift away from the hierarchical culture within the hospital system, many people fall victim to these old ways, especially as medical students. As Liz explains: “You are not alone.” Having experienced bullying first-hand, she was able to not only stand up for herself but also create a revolutionary app called Chnnl. Her story of courage in the face of adversity shows that we should not give up hope and that there is always something to be done. As the Chief Executive Officer (CEO) of Chnnl, Liz Berryman has an important message to New Zealand medical students — wellbeing is important! She has made admirable contributions to collegial wellbeing in health whilst balancing life as a junior doctor, mother, and leader in other areas of medicine including board roles with the New Zealand Medical Association (NZMA) and Health Informatics New Zealand (HiNZ).

The value of mentoring and the ASMS‑NZMSA Mentoring Programme

The wellbeing of medical students is a pressing issue both within New Zealand and globally. The journey through medical school is unique, filled with new experiences, opportunities, learning, challenges, and insights; concurrently, however, there are a variety of stressors and pressures that can negatively impact student wellbeing.1 With increasing awareness, strategies are being implemented to tackle this issue.2 This article will explore common stressors experienced by medical students and the impact of these stressors; the value of mentoring as one avenue to improve student wellbeing; and introduce the exciting Association of Salaried Medical Specialists (ASMS) and New Zealand Medical Students’ Association (NZMSA) Mentoring Programme, launched in 2019 throughout New Zealand.

Australian and New Zealand Medical Students' Attitudes and Confidence Towards Providing Nutrition Care in Practice.

The prevalence of lifestyle-related chronic disease is increasing. Doctors in primary care are ideally placed to support patient nutrition care, but recent reviews show education is still lacking. This study aimed to identify medical students’ attitudes towards the role of nutrition in health, nutrition knowledge, and perceptions of nutrition education, in postgraduate (Australia) and undergraduate (New Zealand) programs in order to identify gaps in nutrition knowledge and skills to better inform future education. Second-year graduate and third-year undergraduate students participated in semi-structured focus groups and interviews. A general inductive approach was used to investigate students’ (1) attitudes toward the role of nutrition in health, (2) nutrition knowledge based on nutrition-specific competencies and (3) perceived adequacy of nutrition education received. Interviews (nine) and focus groups (seven) identified four common themes: (1) role of medical practitioners in nutrition care, (2) barriers to nutrition education, (3) nutrition knowledge, and (4) nutrition-related skills. Students perceive that doctors are well-placed to provide some level of nutrition care, but poor translation of nutrition knowledge to clinical contexts is a key limitation in nutrition education. In summary, nutrition education may be insufficient to support the nutrition-related competency development of the undergraduate and postgraduate student participants in this study. Focusing on the integration of these skills into the curriculum may be a priority.

Medical students’ opinions on professional behaviours: The Professionalism of Medical Students’ (PoMS) study

Introduction: The Professionalism of Medical Students (PoMS) study aimed to develop a comprehensive understanding of Australian and New Zealand (Aus/NZ) medical students’ opinions and experience with professionalism dilemmas.Methods: A confidential, online survey for medical students was developed and distributed to all Aus/NZ medical schools. Students submitted de-identified demographic information, gave opinions on the acceptability of a range of student behaviours for professionally challenging situations, and whether they had encountered similar situations.Results: 3171 medical students participated from all 21 Aus/NZ medical schools (16% of the total student population). Medical students reported encountering many of the professionally challenging situations and had varying opinions on what was acceptable behaviour for the scenarios. In general, students’ opinions were not influenced by the seniority, gender or the type of health professional involved in the scenario. Participant demographic factors appeared to have significant effects on professional opinions – particularly male gender and being a student in the latter stages of the course.Discussion: Medical students’ professional opinions are a complex area. The PoMS data provides a reference point for students, their educators and other health professionals in identifying current student professional behaviour norms, determining the effects of demographic factors on their decision making, and where important gaps exist in medical students’ approaches to professionalism.

Exploring factors that motivate and influence medical students to attend medical school

Introduction: This study explored motivation among a cohort of New Zealand medical students from The University of Auckland. The research questions were: 1) What motivates students to attend medical school? 2) What are the values, beliefs or cultural practices that influence students’ decisions to go to medical school? 3) How do students’ families influence their decisions to go to medical school? Methods: Twenty medical students from The University of Auckland in Years Two and Five of a Bachelor of Medicine and Bachelor of Surgery (MBChB) degree participated in semi-structured focus group interviews. Two cohorts of medical students were involved, Māori and Pacific Admission Scheme students (MAPAS), and non-MAPAS students. An interpretive methodology was used, and data analysed using thematic analysis. Findings: This study found both MAPAS and non-MAPAS students have intrinsic and extrinsic motivation to attend and continue medical school. However, the non-MAPAS students had more individualised motivations to study medicine whereas the MAPAS students were more motivated by collectivism. Family and cultural customs influenced MAPAS students’ motivation to study medicine. Non-MAPAS students were influenced by positive school experiences. Common to both cohorts was the significant influence of family. Non-MAPAS students specified family members’ professions and educational support as influencing factors. In contrast, MAPAS students identified being motivated to study medicine to improve the financial and health situations of their families. Conclusion: All students have different motivations for attending medical school which is influenced by their culture and environment. Culture encompasses the individual and their family, inclusive of ethnicity, beliefs, values and behaviours. Family plays a crucial role in motivating and influencing students to pursue medicine.

Attrition among New Zealand medical students completing research degrees: A20-year analysis.

IntroductionNot all medical students who intercalate research degrees go on to completion. No study to date has investigated the specific reasons. Understanding this minority would fill an important research gap.MethodsA list was obtained of intercalating medical students who enrolled at our institution between 1995 and 2014. Students who withdrew from an intercalated research degree were then invited to complete an online survey via email.ResultsOver the study period, 178 medical students commenced an intercalated honours or PhD degree with their medical degree, and 13 students withdrew from that program, giving an overall attrition rate of 7.3%. Students who withdrew from the intercalated degree were also more likely to withdraw from their medical degree (40%); this is compared with 3.6% of students who completed the intercalated degree, but eventually withdrew from their medical degree.DiscussionDemographics of this cohort were not dissimilar to those of completing students. Although withdrawing students had a higher exit rate from the medical degree, the rate of research involvement remained similar pre- and post-intercalation. The most commonly cited reasons for withdrawal were decreased satisfaction with research, and conflict with supervisors.

Ethnic bias and clinical decision-making among New Zealand medical students: an observational study

BackgroundHealth professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making.MethodsAll final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression.ResultsThree hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses.ConclusionsNZ medical students demonstrated ethnic bias, although overall this was not associated with clinical decision-making. This study both adds to the small body of literature internationally on racial/ethnic bias among medical students and provides relevant and important information for medical education on indigenous health and ethnic health inequities in New Zealand.

Does your pig go 'knor'? Medical students' skills in using animal sounds as a cross-cultural paediatric engagement tool.

The development of verbal communication skills is an important aspect of medical education asaccurate assessment in part relies on effectively obtaining information from patients. When assessing children of different cultural or ethnic backgrounds, young medics may find effective verbal communication difficult because they lack understanding about what children are really like. Animal noises are a likely tool with which to successfully engage with young children. However, these differ by culture and it is unclear whether young New Zealand medical students will be adept at effectively engaging and communicating with foreign children via this mode of communication. We therefore assessed whether medical students in our country were able to accurately reproduce animal noises from different cultures. Six current medical students from New Zealand (with English as their first language) were assessed on their ability to reproduce animal noises from three different foreign languages: Dutch, Arabic and Danish. The animals selected were duck, cow, dog, frog, pig and sheep. Students were played recordings of the foreign-language animal noises, and were then rated on a scale of 1-5 (1=poor, 5=outstanding) on their ability to reproduce the noise. Arabic animal noises were reproduced more convincingly than those in the other languages (mean score: 3.8), of which animal noises in Danish were worst (mean score: 3.1). Perhaps unsurprisingly, sheep noises were reproduced best (mean score: 4.7), whereas pig noises were the least convincing (mean score: 2.2). Findings indicate that New Zealand medical students are likely to be better than average at reproducing animal noises in the languages examined, and are perhaps socially and genetically predisposed to replicating sheep noises successfully. They are therefore likely to make good paediatric registrars and fabulous au pairs. The study highlights the more serious issues of multicultural understanding and tolerance of other cultures, and provides a novel paediatric engagement tool for those young medics who do not really 'get' children.

New Zealand Medical Students Have Positive Attitudes and Moderate Confidence in Providing Nutrition Care: A Cross-Sectional Survey

Throughout the world, medical students and doctors report inadequate nutrition education and subsequently lack of knowledge, attitude, and skills to include nutrition in patient care. This study described New Zealand’s students’ attitudes to and self-perceived skills in providing nutrition care in practice as well as perceived quantity and quality of nutrition education received in training. 183 medical students from New Zealand’s largest medical school (response rate 52%) completed a 65-item questionnaire, partially validated, using 5-point Likert scales. Students believed incorporating nutrition care into practice is important, yet they were less confident patients improve nutrition behaviours after receiving this care. Students were confident in skills related to nutrition in health and disease but less confident in skills related to general food knowledge. Greater quantity and quality of nutrition education received was associated with greater self-perceived skills in providing nutrition care to patients but not with attitudes towards incorporating nutrition care into practice. This cohort of New Zealand medical students places similarly high importance on nutrition care as students and doctors from other countries. Further investigations beyond graduation are required to inform whether additional nutrition education is warranted for these doctors.

Doctors' attitudes and confidence towards providing nutrition care in practice: Comparison of New Zealand medical students, general practice registrars and general practitioners

Improvements in individuals' nutrition behaviour can improve risk factors and outcomes associated with lifestyle-related chronic diseases. This study describes and compares New Zealand medical students, general practice registrars and general practitioners' (GPs') attitudes towards incorporating nutrition care into practice, and self-perceived skills in providing nutrition care. A total of 183 New Zealand medical students, 51 general practice registrars and 57 GPs completed a 60-item questionnaire investigating attitudes towards incorporating nutrition care into practice and self-perceived skills in providing nutrition care. Items were scored using a 5-point Likert scale. Factor analysis was conducted to group questionnaire items and a generalised linear model compared differences between medical students, general practice registrars and GPs. All groups indicated that incorporating nutrition care into practice is important. GPs displayed more positive attitudes than students towards incorporating nutrition in routine care (p<0.0001) and performing nutrition recommendations (p<0.0001). General practice registrars were more positive than students towards performing nutrition recommendations (p=0.004), specified practices (p=0.037), and eliciting behaviour change (p=0.024). All groups displayed moderate confidence towards providing nutrition care. GPs were more confident than students in areas relating to wellness and disease (p<0.0001); macronutrients (p=0.030); micronutrients (p=0.010); and women, infants and children (p<0.0001). New Zealand medical students, general practice registrars and GPs have positive attitudes and moderate confidence towards incorporating nutrition care into practice. It is possible that GPs' experience providing nutrition care contributes to greater confidence. Strategies to facilitate medical students developing confidence in providing nutrition care are warranted.