Jo Hart

Behaviour and burnout in medical students

Background Burnout is prevalent in doctors and can impact on job dissatisfaction and patient care. In medical students, burnout is associated with poorer self-rated health; however, it is unclear what factors influence its development. This study investigated whether health behaviours predict burnout in medical students. Methods Medical students (n=356) at the Universities of St Andrews and Manchester completed an online questionnaire assessing: emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA), alcohol use, physical activity, diet, and smoking. Results Approximately 55% (54.8%) of students reported high levels of EE, 34% reported high levels of DP, and 46.6% reported low levels of PA. Linear regression analysis revealed that year of study, physical activity, and smoking status significantly predicted EE whilst gender, year of study, and institution significantly predicted DP. PA was significantly predicted by alcohol binge score, year of study, gender, and physical activity. Conclusions Burnout is present in undergraduate medical students in the United Kingdom, and health behaviours, particularly physical activity, predict components of burnout. Gender, year of study, and institution also appear to influence the prevalence of burnout. Encouraging medical students to make healthier lifestyle choices early in their medical training may reduce the likelihood of the development of burnout.Background Burnout is prevalent in doctors and can impact on job dissatisfaction and patient care. In medical students, burnout is associated with poorer self-rated health; however, it is unclear what factors influence its development. This study investigated whether health behaviours predict burnout in medical students. Methods Medical students (n=356) at the Universities of St Andrews and Manchester completed an online questionnaire assessing: emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA), alcohol use, physical activity, diet, and smoking. Results Approximately 55% (54.8%) of students reported high levels of EE, 34% reported high levels of DP, and 46.6% reported low levels of PA. Linear regression analysis revealed that year of study, physical activity, and smoking status significantly predicted EE whilst gender, year of study, and institution significantly predicted DP. PA was significantly predicted by alcohol binge score, year of study, gender, and physical activity. Conclusions Burnout is present in undergraduate medical students in the United Kingdom, and health behaviours, particularly physical activity, predict components of burnout. Gender, year of study, and institution also appear to influence the prevalence of burnout. Encouraging medical students to make healthier lifestyle choices early in their medical training may reduce the likelihood of the development of burnout.

You've got to know the rules to play the game: how medical students negotiate the hidden curriculum of surgical careers

The hidden curriculum may be framed as the culture, beliefs and behaviours of a community that are passed to students outside formal course offerings. Medical careers involve diverse specialties, each with a different culture, yet how medical students negotiate these cultures has not been fully explored. Using surgery as a case study, we aimed to establish, first, whether a specialty‐specific hidden curriculum existed for students, and second, how students encountered and negotiated surgical career options.

Preparing medical students to facilitate lifestyle changes with obese patients: a systematic review of the literature.

Purpose Doctors will increasingly encounter opportunities to support obese patients in lifestyle change efforts, but the extent to which medical schools prepare their students for this challenge is unknown. Further, despite evidence indicating theory-based techniques are effective in facilitating patients’ behavioral changes, the methods taught to medical students and the means of content delivery are unclear. The authors reviewed the literature to investigate how effective educational interventions are in preparing medical students to facilitate lifestyle changes with obese patients. Method The authors systematically searched Excerpta Medica (EMBASE), PsycINFO, MEDLINE, and Scopus for educational interventions on obesity management for medical students published in English between January 1990 and November 2010 and matching PICOS (Population, Interventions, Comparators, Outcomes, Study design) inclusion criteria. Results Results of a narrative synthesis are presented. Of 1,680 studies initially identified, 36 (2%) full-text articles were reviewed, and 12 (1%) were included in the final dataset. Eleven (92%) of these studies had quantitative designs; of these, 7 (64%) did not include control groups. Nine (75%) of the 12 studies were atheoretical, and 4 (33%) described behavior management strategies. Despite positive reported outcomes regarding intervention evaluations, procedures to control for bias were infrequently reported, and conclusions were often unsupported by evidence. Conclusions Evidence from this systematic review revealed data highly susceptible to bias; thus, intervention efficacy could not be determined. Additionally, evidence-based strategies to support patients’ obesity-related behavior changes were not applied to these studies, and thus it remains unknown how best to equip medical students for this task.

Nursing students' perceptions of obesity and behaviour change: implications for undergraduate nurse education

BACKGROUND Rates of obesity are rising and previous research suggests this is not effectively dealt with in healthcare settings. Nurses are increasingly involved in lifestyle management of patients, and understanding the barriers to discussing weight with patients is likely to increase successful weight management. Obesity management is a role that nursing students will need to be equipped with and more likely to be targeted for future training developments in tackling the increasing rates of obesity. OBJECTIVES To explore the perceptions of obesity, potential barriers to successful patient weight management and training needs of nursing students. METHODS Qualitative, semi-structured interviews were conducted with 20 nursing students. Audiotaped interviews were transcribed verbatim and analysed using an inductive thematic approach informed by principles of grounded theory. RESULTS Participants reported the challenge of managing obesity in healthcare practice, such as the impact of negative attitudes in healthcare practice on patient care. Although perceived as core to their training, nursing students lacked the confidence and techniques to discuss weight management with patients. Participants also perceived the nursing curriculum as lacking a focus on obesity, and reported a need for advanced communication skills training. CONCLUSION Although seen as important, nurses lack the skills to facilitate weight management, leading to nurses failing to broach the issue. PRACTICE IMPLICATIONS Nurse educators should consider the perceptions of current students when making curriculum developments in this area.

Communication skills: An essential component of medical curricula. Part I: Assessment of clinical communication: AMEE Guide No. 51

This AMEE Guide in Medical Education is Part 1 of a two part Guide covering the issues of Communication. This Guide has been written to provide guidance for those involved in planning the assessment of clinical communication and provides guidance and information relating to the assessment of various aspects of clinical communication; its underlying theory; its practical ability to show that an individual is competent and its relationship to students’ daily performance. The advantages and disadvantages of assessing specific aspects of communication are also discussed. The Guide draws attention to the complexity of assessing the ability to communicate with patients and healthcare professionals, with issues of reliability and validity being highlighted for each aspect. Current debates within the area of clinical communication teaching are raised: when should the assessment of clinical communication occur in undergraduate medical education?; should clinical communication assessment be integrated with clinical skills assessment, or should the two be separate?; how important should the assessment of clinical communication be, and the question of possible failure of students if they are judged not competent in communication skills? It is the aim of the authors not only to provide a useful reference for those starting to develop their assessment processes, but also provide an opportunity for review and debate amongst those who already assess clinical communication within their curricula, and a resource for those who have a general interest in medical education who wish to learn more about communication skills assessment.

Students' hopes and fears about early patient contact: Lessons to be learned about preparing and supporting students during the first year

Background: Medical students increasingly have contact with real patients (‘early patient contact’, EPC) from the beginning of their first year. Little is known about their expectations of meeting patients at this time. Understanding their hopes and fears might usefully influence the design and delivery of EPC. Aim: To explore students’ views of EPC before arrival at medical school and the impact of EPC on them after 1 year. Methods: A two-part study comprising a pre-registration questionnaire, with open-ended questions, sent to the complete year group, and four focus groups conducted after 1 year with randomly selected students. Results: Students anticipated benefits from EPC, especially in promoting personal and professional development. After 1 year most of their hopes were realized. They feared feeling inadequate and doing harm to patients or themselves. Fears were reinforced when students felt underprepared, were not made welcome on hospital wards and treated disrespectfully by some staff. Conclusion: Understanding how students anticipate meeting patients for the first time is crucial to maximize the educational potential of EPC. Students’ preparation for EPC and the organization of these real patient encounters are of paramount importance in determining to what extent their hopes and fears are realized and their consequent learning.

Medical undergraduates' use of behaviour change talk: the example of facilitating weight management

BackgroundObesity, an increasing problem worldwide, is a leading cause of morbidity and mortality. Management principally requires lifestyle (i.e. behavioural) changes. An evidence-base exists of behaviour change techniques for weight loss; however, in routine practice doctors are often unsure about effective treatments and commonly use theoretically-unfounded communication strategies (e.g. information-giving). It is not known if communication skills teaching during undergraduate training adequately prepares future doctors to engage in effective behaviour change talk with patients. The aim of the study was to examine which behaviour change techniques medical undergraduates use to facilitate lifestyle adjustments in obese patients.MethodsForty-eight medical trainees in their clinical years of a UK medical school conducted two simulated consultations each. Both consultations involved an obese patient scenario where weight loss was indicated. Use of simulated patients (SPs) ensured standardisation of key variables (e.g. barriers to behaviour change). Presentation of scenario order was counterbalanced. Following each consultation, students assessed the techniques they perceived themselves to have used. SPs rated the extent to which they intended to make behavioural changes and why. Anonymised transcripts of the audiotaped consultations were coded by independent assessors, blind to student and SP ratings, using a validated behaviour change taxonomy.ResultsStudents reported using a wide range of evidence-based techniques. In contrast, codings of observed communication behaviours were limited. SPs behavioural intention varied and a range of helpful elements of student’s communication were revealed.ConclusionsCurrent skills-based communication programmes do not adequately prepare future doctors for the growing task of facilitating weight management. Students are able to generalise some communication skills to these encounters, but are over confident and have limited ability to use evidence-based theoretically informed techniques. They recognise this as a learning need. Educators will need to tackle the challenges of integrating theoretically informed and evidence based behaviour change talk within medical training.

Are medical educators following General Medical Council guidelines on obesity education: if not why not?

BackgroundAlthough the United Kingdom’s (UK’s) General Medical Council (GMC) recommends that graduating medical students are competent to discuss obesity and behaviour change with patients, it is difficult to integrate this education into existing curricula, and clinicians report being unprepared to support patients needing obesity management in practice. We therefore aimed to identify factors influencing the integration of obesity management education within medical schools.MethodsTwenty-seven UK and Irish medical school educators participated in semi-structured interviews. Grounded theory principles informed data collection and analysis. Themes emerging directly from the dataset illustrated key challenges for educators and informed several suggested solutions.ResultsFactors influencing obesity management education included: 1) Diverse and opportunistic learning and teaching, 2) Variable support for including obesity education within undergraduate medical programmes, and 3) Student engagement in obesity management education. Findings suggest several practical solutions to identified challenges including clarifying recommended educational agendas; improving access to content-specific guidelines; and implementing student engagement strategies.ConclusionsStudents’ educational experiences differ due to diverse interpretations of GMC guidelines, educators’ perceptions of available support for, and student interest in obesity management education. Findings inform the development of potential solutions to these challenges which may be tested further empirically.

Training Obstetricians and Gynaecologists to be emotionally intelligent.

The concept of emotional intelligence (EI), a model that encompasses all of the skills in the patient–doctor relationship, has been applied to medical education in recent years. Doctors in obstetrics and gynaecology (O&G) often deal with emotionally demanding situations for themselves and for their patients, and therefore, EI skills may be vital and should be part of any training curriculum. Using novel methodology, 16 O&G consultants from across the North-West of England were asked to investigate (using a coding manual) randomly allocated modules of the RCOG O&G training curriculum, to look for constructs of EI and these were found both implicitly and explicitly, highlighting the importance of EI to O&G. By focussing on EI training within the curriculum, to improve the patient–doctor relationship, patient satisfaction may be increased and litigation reduced in a specialty that is already highly litigious.

When is it ok to tell patients they are overweight? General public’s views of the role of doctors in supporting patients’ dieting and weight management

The objective was to explore the general public’s views on the role of health professionals in the management of weight with diet and the implementation of behaviour change. Semi-structured interviews were conducted. An inductive grounded theory approach utilised a coding framework; recurring concepts/themes explored in future interviews and thematic saturation achieved. Two themes summarised views on the role of health professionals in supporting dieting and weight management: responsibility to initiate talk and what patients expect. Individuals perceive health professionals as having a role in their weight management. Individuals have disparate views about responsibility for initiation of weight management talk.