Edgar Voltmer

Perceived medical school stress and the development of behavior and experience patterns in German medical students

Background: Longitudinal data about the development of health risks and resources in relation to the performance of medical students are limited. Aims: To evaluate the development of study-related experience and the correlation to performance. Method: Medical students in the first (2006), second (2008), and fifth years (2011) of their studies were surveyed with standard instruments for quality of life, study-related behavior and experience, perceived medical school stress, anxiety and depression, and grades in their first major exam. Results: The proportion of students with a healthy behavior and experience pattern decreased from 47.3% in the first year to 36.9% in the second year and 17.6% in the fifth year. This corresponded to an increase in the proportion of students at risk for burnout (7.1% first, 20% second, 19% fifth year). Students with a healthy behavior and experience pattern scored higher in self-perceived performance (p < 0.05) and objective grades. Stress and risk for burnout were important predictors for anxiety and depression. Conclusions: The decrease in health and the increase in risk patterns indicate a need for prevention and health promotion that should not only focus on individual behavior but also address the contextual factor of study organization within medical school.

Study-related health and behavior patterns of medical students: A longitudinal study

Background: Little is known about specific health risks and resources and their development influencing medical students’ stress. Aim: To evaluate the development of quality of life and study-related behavior and experience patterns among medical students. Methods: Data were collected in the first (n = 112 of 182 in 2006) and the fourth semesters (n = 164 of 176 in 2008). The instruments “Work-Related Behavior and Experience Patterns” (AVEM, including four main patterns: “Health”, “Unambitious,” “Overexertion,” “Burnout”) and “Short Form-12 Health Survey (SF-12)” were used at both points in time. Results: The medical students scored significantly lower on mental health compared with reference samples of young adults. The proportion of students with a healthy pattern decreased from 47.3% (95% CI 38.1–56.5%) in the first semester to 36.9% (29.4–44.4%) in the fourth semester. This corresponded to an increase in the proportion of students at risk for burnout from 7.1% (2.3–11.9%) to 20% (13.8–26.2%). At both time points, female students had a higher risk for overexertion and a lower prevalence of a healthy pattern than male students. Conclusion: Our data provide evidence for a decrease in the healthy pattern and an increase in the burnout pattern. Intervention is needed, especially for students at risk for burnout.

Physicians’ perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States

BackgroundWe lack national and cross-national studies of physicians’ perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway.MethodsWe analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,213), the U.S. (n = 6,628), and Norway (n = 657), examining demographics, job satisfaction, and professional autonomy.ResultsAmong U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians’ perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians.ConclusionsU.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.

Health-promoting factors in the freshman year of medical school: a longitudinal study.

The freshman year of medical school is a stressful period in the lives of future doctors. Resilience to this stress differs greatly, leading to different health outcomes. Less resilient students, whose health may deteriorate early in their education, are at greater risk for developing stress‐related diseases. Early identification of individuals at risk and the provision of tailored health‐promoting interventions might prevent this.

Work-related behaviour and experience patterns of nurses in different professional stages and settings compared to physicians in Germany

Working in a health-care profession is correlated with high levels of stress and potential burnout that are likely to increase over time. Few studies differentiate psychosocial stress between nurses in different clinical settings or professional stages. In this cross-sectional study, we compared the work-related behaviour and experience of nurses (n=389) and physicians (n=344) and of nurses across different career stages and clinical settings in Germany. Nurses had the lowest proportion of a healthy behaviour and experience pattern (11.6%) compared with student nurses (32.6%), senior nurses (25%), and physicians (16.7%). They also had the highest proportion of a burnout-related behaviour and experience pattern (32.8% vs 26.1% of student nurses, 18.3% of senior nurses, and 27.3% of physicians). In comparison with medical nurses, psychiatric nurses presented a significantly (P<0.01) lower proportion with a healthy (10.6% vs 21.8%) and burnout-related behaviour pattern (23.5% vs 29.6%), and a higher proportion showing a low commitment to work (61.4% vs 34.4%). Differences in health-related dimensions were primarily observed in the domains of professional commitment and stress resistance. The observed differences in behaviour and experience patterns as a function of health-care settings and career stages emphasize the need for specific interventions.

[Religiosity, spirituality, health and work-related behaviour patterns in pastors of two free protestant denominations].

BACKGROUND Epidemiological data show psychosocial health risks of pastors. This study should therefore identify psychosocial risk factors and health resources including religiosity and spirituality in profession related behaviour and experience of pastors. Methods Pastors of two protestant denominations were surveyed with three standard instruments (AVEM, SF-12, BMMRS). RESULTS Only a small fraction of pastors presented a healthy behaviour and experience pattern (13.9% SDA; 10.1% FEG). A burnout-related risk pattern was found in 28.3% of SDA and 37.2% of FEG pastors. Pastors with a healthy pattern scored higher in physical and mental health and selected scales of religiosity/spirituality than those with a pattern in risk for burnout. CONCLUSIONS The results show distinct psychosocial strain patterns of pastors. Religiosity and spirituality may be an important resource.

Measurement of specific medical school stress: translation of the “Perceived Medical School Stress Instrument” to the German language

Objective: Medical students encounter specific stressors during their studies. As a result, they develop anxiety, depression and burnout symptoms more frequently than their similarly aged, but employed counterparts. In 1984, Vitaliano et al. published a 13-item instrument for the measurement of stress specific to medical school: the “Perceived Medical School Stress Instrument“ (PMSS). Since then, it has been widely applied and validated in English-speaking countries. No German version of the PMSS exists to date. Thus, our aim was to translate the instrument into the German language in order to be able to measure medical school stress in German-speaking countries. Method: The items of the PMSS were translated into German by three separate researchers. The resulting translations were compared and combined with each other to establish a first German version of each item in the PMSS. These items were then translated back into English by two native English speakers to validate the correct primary translation. Based on a revised German version, a cognitive debriefing with 19 German medical students and a theoretical testing on 169 German medical students, the final German translations for each of the 13 items were determined. Results: The PMSS was easily translated into German and there was a high congruency between the primary translations into German and the secondary translations back into English. Incongruities between the translations were solved quickly. The assessment of the German equivalent of the PMSS showed good results regarding its reliability (Cronbach’s Alpha 0.81). Conclusion: A German version of the PMSS is now available for measuring the medical school related stress in German-speaking countries.

Health status and preventive health behavior of music students during university education: Merging prior results with new insights from a German multicenter study:

Musicians are at high risk of developing playing-related health problems. A considerable number of musicians suffer from severe health issues even during their university education. In previous studies using similar music student populations, health status and preventive health behavior could be classified into three groups. The first group of students did not report playing-related health problems and did not engage in preventive activities. The second group of students experienced rather low-level playing-related health problems and practiced preventive activities. The third group reported a rather high frequency of playing-related health problems and all of them were taking medication. These results were obtained from studies done at one German university of music. In order to compare these results with a nationwide sample of music students, a multicenter study at five German universities of music was performed. A total of 288 music students participated in the first survey at the beginning of their university education, 142 in the second survey at the start of their third semester and 75 in the third survey at the start of the last year of their university education. The data was analyzed using the same methods as the prior studies. The results confirmed the group classifications identified in previous studies. While approximately half the students indicated that they participated in preventive health behavior in the first survey, in the following two surveys more than three-quarters of the students reported practicing such activities during the course of their university education. Nevertheless, in all three surveys a large number (about a third) of music students reported playing-related health problems.

Predictors of Participation of Sophomore Medical Students in a Health-Promoting Intervention: An Observational Study

Medical students and doctors have to be particularly stress-resilient, as both medical education and practice are considered very stressful. Specific stressors can lead to increased risks of developing, for example, depression, anxiety and burnout. Relaxation techniques have proven to be effective for the prevention of these outcomes in student populations. However, only a very few medical students practice relaxation techniques regularly early on in their studies. Furthermore, it is unclear which students make use of stress-management offers and hence whether vulnerable students are generally reachable. Therefore, the aim of our study was to explore predictors of participating in a voluntary stress management course for sophomore medical students. One cohort of freshmen at a German medical school was surveyed at the end of the freshman year [t1] and at the end of the sophomore year [t2]. In addition to sociodemographic information, we captured perceived study stress, self-rated general health and mental health and dimensions of study-related behaviour and experience as potential predictors of participation at t1. During the sophomore year, we offered the participants a progressive muscle relaxation (PMR) beginners’ course. At t2, we registered participation status. We used binary logistic regression analyses in order to assess correlations between potential predictors and participation. About one third of the whole class took part in the course. The main reason for non-participation was “no time”. Being female and higher levels of anxiety were the strongest predictors of course participation. Career ambition (the higher, the less likely to participate) and emotional distancing (the higher, the more likely to participate) were further significant predictors. Future interventions should be attractive to both male and female medical students. Ideally, for every hour of stress management teaching, the curriculum should be cut by at least the same amount of time.

Identifikation mit dem Studiengang

ZusammenfassungHintergrundEine hohe Identifikation mit einer Gruppe kann sich positiv auf das Wohlbefinden auswirken. In dieser Studie wurde getestet, inwiefern sich diese Ergebnisse auch auf den Kontext Universität und hierbei auf den Kontext Medizin übertragen lassen. Dabei wurde auch untersucht, inwiefern gerade in einem so leistungsorientierten Gruppenkontext wie dem Medizinstudium eine hohe Identifikation auch zu einem Risikofaktor für Selbstüberforderung werden kann.Material und MethodenDiese Studie ist Teil der LUST-Studie („Lübeck University Student Trial“), einer seit 2011 laufenden Längsschnittstudie zur Studierendengesundheit an der Universität zu Lübeck. Für diese Studie wurden 336 Medizinstudierenden im Juni 2015 zur ihrer Identifikation mit Medizinstudiengang, den studiumsbezogenen Verhaltens- und Erlebensmustern (AVEM) sowie zu ihrer allgemeinen und seelischen Gesundheit befragt.ErgebnisseIdentifikation hat insgesamt einen positiven Einfluss auf die Gesundheit der Medizinstudierenden. Die Betrachtung der AVEM-Muster zeigt aber auch, dass in diesem positiven Gesamteffekt zwei gegensätzliche indirekte Effekte der Identifikation liegen: ein positiver indirekter Effekt vermittelt über ein gesundes Muster und ein negativer indirekter Effekt vermittelt über ein Muster der Selbstüberforderung.DiskussionDiese Studie zeigt, dass sich eine hohe Identifikation auch im Kontext Universität grundlegend positiv auf die Gesundheit auswirkt. Sie zeigt aber auch, dass eine hohe Identifikation mit einem erhöhten Risiko zur Selbstüberforderung verbunden sein kann. Dies könnte gerade in sehr leistungsorientierten Gruppenkontexten wie dem Medizinstudium zu einem Risikofaktor werden – v. a. dann, wenn selbstgesetzte Leistungsziele von tatsächlichen Leistungen abweichen.AbstractBackgroundHigh group identification has a positive impact on wellbeing. In this study, we tested whether these results could be transferred to the university context and, more precisely, to the context of medical school. Regarding medical school as a high-achievement-oriented group context, we also investigated whether high identification could become a risk factor for obsessive demands on the self.Material and methodsThis research is part of the LUST Study (Lübeck University Student Trial), a longitudinal survey at Lübeck University investigating students’ health. For this study, we surveyed 336 students from medical school during June 2015 regarding their identification with the medical school, their study-related behaviour and experience patterns (AVEM) and their general physical and mental health.ResultsIdentification has a positive effect on medical students’ health. However, with regard to the AVEM pattern, our study demonstrates that within this total positive effect there are two opposing indirect effects of high identification: a positive indirect effect via a healthy pattern and a negative indirect effect via a pattern of over-commitment.DiscussionThis study highlights that, also in the university context, high identification has a positive impact on health. However, it also proves that high identification can become a risk factor for obsessive demands on the self. This negative impact is more likely to become a risk factor in high-achievement group contexts, such as medical school, and, more particularly, when self-defined performance goals do not correspond to real performance.