The Price of Productivity: Evaluating the Cost of a Research Year.

OBJECTIVE: Research years during medical school are becoming increasingly common amongst applicants to competitive residency programs. As many of these positions are unpaid, it is important to consider the financial implications of these experiences and the feasibility of participation from students of all backgrounds. This study aims to quantify the cost of a research year during medical school. DESIGN/SETTING: We identified the top 50 NIH-funded medical schools of 2022 and obtained cost-of-living information for each of their respective counties. Estimated loan interest accrual resulting from a research year was calculated using information on the cost of attendance to medical school and annual interest rates for federal education loans. Cost-of-living calculations were stratified by geographic region, and interest accrual calculations by timing of research year and attendance at public versus private medical schools. RESULTS: Top 50 NIH-funded medical schools in the West are located in counties with the highest mean and median costs of living, each approaching nearly $45,000 per year. Medical schools in the Midwest are located in counties with the lowest mean and median cost of living, at less than $36,000 annually. Estimated loan interest accrual resulting from a research year ranges from $3177 to $17,789, depending on timing of the research year and type of medical school attended. CONCLUSIONS: This study exemplifies the significant financial burden that a research year can impose on medical students. As more residency applicants pursuing competitive specialties opt for research years during medical school, it is important to consider the associated financial implications. Many research year opportunities are unpaid or underpaid, which may prevent interested individuals from participating; this is especially the case for those who are from lower socioeconomic backgrounds. Moving forward, it is imperative that we ensure the availability of equitable and funded research year opportunities for students of all backgrounds.

Financial Literacy in Plastic Surgery Training: Importance and Current Status.

BACKGROUND: Medical training is known to impose financial burden on trainees, which has been shown to contribute to burnout, even possibly compromising patient care. Financial literacy allows for management of financial situations affecting professional and personal life. The authors aimed to evaluate the financial status and knowledge among plastic surgery residents. METHODS: A survey regarding finances and financial literacy of plastic surgery residents was sent to all the current accredited U.S. residency programs. The same survey was distributed internally. A descriptive analysis was performed, and multiple Fisher exact tests and a t test evaluated comparisons. RESULTS: Eighty-six residents were included. Most trainees had a student loan (59.3%), with 22.1% having loans more than $300,000. A majority had at least one personal loan debt other than educational (51.1%). Residents with more debt were significantly less likely to pay off their balances monthly. A total of 17.4% of trainees had no plan for how to invest their retirement savings, whereas 55.8% reported not knowing how much they need to save to retire. One in five trainees did not feel prepared to manage personal finances/retirement planning after graduation, a majority had no formal personal finance education in their curriculum, and 89.5% agreed that financial literacy education would be beneficial. Our institutional data largely mirrored national data. CONCLUSIONS: Many residents are lacking in financial knowledge, despite most having significant debt. Additional financial literacy education is needed in plastic surgery training. Curricula development at an institutional or national society level are possible paths toward a coordinated response to this need.

Exploring Pharmacy Student Experiences with Student Debt and Perspectives on Future Burnout and Loan Relief.

OBJECTIVE: Pharmacy students with substantial educational debt are at risk for excessive workloads, burnout, and clinical errors. During the COVID-19 pandemic, policies addressing economic hardships for all student debt borrowers included temporary suspension of monthly payments and 0% interest during the pause. This study aimed to understand student-level factors regarding student debt from the lived experiences of current pharmacy students and aimed to understand how current pharmacy students view temporary loan relief. METHODS: We used semi-structured interviews of pharmacy students across 4 years of progression in their pharmacy program to better understand student experiences with debt, different factors that may influence the impact of student debt on short-term and long-term outcomes for students, and student perspectives on debt relief policies and potential solutions. Our thematic analysis was grounded in existing evidence and a conceptual framework, while also allowing codes to emerge directly from the data. RESULTS: A total of 20 pharmacy students were interviewed with a median student debt of $77,000, with debt amounts ranging from $0 to $209,000. Students described what mediating factors influenced their experiences, the influence of student debt on clinician burnout, and other outcomes impacted by student debt. Six overarching themes emerged relevant to current students: student debt influences education and career decisions, debt is risky given the saturated pharmacy market, debt is an accepted burden, debt will inhibit starting a life, the COVID-19 loan relief is revealing, and early financial education is needed. CONCLUSION: Pharmacy students burdened with debt described a variety of different experiences and attitudes toward that debt and provided their perspectives on how student debt influences short-term education and career decisions. While students accept the trade-off of debt for their education as an inevitable burden, reported coping mechanisms and strategies shared suggest some solutions may be available to ameliorate this burden.

Comparing Naturalistic Mental Health Expressions on Student Loan Debts Using Reddit and Twitter.

PURPOSE: The primary objective of this study was to identify patterns in users' naturalistic expressions on student loans on two social media platforms. The secondary objective was to examine how these patterns, sentiments, and emotions associated with student loans differ in user posts indicating mental illness. MATERIAL AND METHOD: Data for this study were collected from Reddit and Twitter (2009-2020, n = 85,664) using certain key terms of student loans along with first-person pronouns as a triangulating measure of posts by individuals. Unsupervised and supervised machine learning models were used to analyze the text data. RESULTS: Results suggested 50 topics in reddit finance and 40 each in reddit mental health communities and Twitter. Statistically significant associations were found between mental illness statuses and sentiments and emotions. Posts expressing mental illness showed more negative sentiments and were more likely to express sadness and fear. DISCUSSION AND CONCLUSION: Patterns in social media discussions indicate both academic and non-academic consequences of having student debt, including users' desire to know more about their debts. Interventions should address the skill and information gaps between what is desired by the borrowers and what is offered to them in understanding and managing their debts. Cognitive burden created by student debts manifest itself on social media and can be used as an important marker to develop a nuanced understanding of people's expressions on a variety of socioeconomic issues. Higher volumes of negative sentiments and emotions of sadness, fear, and anger warrant immediate attention of policymakers and practitioners to reduce the cognitive burden of student debts.

Impact of Service-Based Student Loan Repayment Program on the Primary Care Workforce.

PURPOSE: As the average level of medical education indebtedness rises, physicians look to programs such as Public Service Loan Forgiveness (PSLF) and National Health Service Corps (NHSC) to manage debt burden. Both represent service-dependent loan repayment programs, but the requirements and program outcomes diverge, and assessing the relative uptake of each program may help to inform health workforce policy decisions. We sought to describe variation in the composition of repayment program participant groups and measure relative impact on patient access to care. METHODS: In this bivariate analysis, we analyzed data from 10,677 respondents to the American Board of Family Medicine's National Graduate Survey to study differences in loan repayment program uptake as well as the unique participant demographics, scope of practice, and likelihood of practicing with a medically underserved or rural population in each program cohort. RESULTS: The rate of PSLF uptake tripled between 2016 and 2020, from 7% to 22% of early career family physicians, while NHSC uptake remained static at 4% to 5%. Family physicians reporting NHSC assistance were more likely than those reporting PSLF assistance to come from underrepresented groups, demonstrated a broader scope of practice, and were more likely to practice in rural areas (23.3% vs 10.8%) or whole-county Health Professional Shortage Areas (12.5% vs 3.7%) and with medically underserved populations (82.2% vs 24.2%). CONCLUSIONS: Although PSLF supports family physicians intending to work in public service, their peers who choose NHSC are much more likely to work in underserved settings. Our findings may prompt a review of the goals of service loan forgiveness programs with potential to better serve health workforce needs.

Perception of Debt During Resident Education-A Systematic Review.

Debt is a common issue among medical residents in the United States. This review attempts 1) to evaluate the level of debt among residents, 2) to assess perceptions toward debt among residents, 3) to determine debt-management options pursued, and 4) to gauge whether levels of debt affect resident career choices. A systematic literature search of articles published between January 2012 and January 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed. The combination of search terms of (financial literacy OR debt) AND (residency OR graduate medical education) were utilized. Primary outcome measures assessed were the levels of debt and perceptions toward the debt. Secondary outcome measures were debt-management options pursued and whether debt affected career choices for residents. Twenty-one studies evaluating a total of 15,585 residents were included in this systematic review. Levels of debt greater than $200,000 were not uncommon across residents and debt burdens are increasing. Greater levels of debt are associated with increased stress and anxiety. Residents reported multiple debt-management options pursued, including loan forbearance, moonlighting, income-based repayment models, military financial support, and loan forgiveness programs. Those with increased levels of debt were less likely to pursue subspecialty training and academic employment positions. The findings conclude that residents carry a substantial amount of debt, and it is a common source of stress and anxiety. Although there are many different avenues that are pursued for debt repayment, levels of debt appear to affect decisions to pursue subspecialty training and to pursue academic positions. Strategies or programs aimed at reducing the debt burden felt by residents could be of great value.

"I didn't give it enough respect" - an evaluation of preparation strategies used by GP trainees for the AKT.

The Applied Knowledge Test (AKT) is one third of the licensing exam to become a General Practitioner in the United Kingdom. It is a computer-based, machine-marked multiple-choice examination with an overall pass rate of around 70%. Statistics reveal international medical graduates to have lower rates of passing. The aim of this evaluation was to determine the key features of preparation for the exam used by successful candidates. A questionnaire survey was sent to recently successful general practice trainees in Southampton. The results were further informed by a group interview and three in-depth interviews. A series of six areas were identified within the exam preparation that featured as common areas for all candidates. Further analysis showed the parameters around these areas suggesting the ability to maximise the candidates' chances of success. The areas included: preparation; time management; expectations; peer support; change of approach and impact on trainee mental health. A period of at least 10 hours per week for at least three months revision, using four to six resources and using question banks to consolidate learning rather than as a primary tool were found to be the key parameters with successful candidates. When to take the exam should be discussed with the trainer, the difficulty of the exam needs to be acknowledged by candidates, working in study groups can be beneficial and planning of the approach to revision was found to be essential. The impact of failure on trainee mental health must not be underestimated.

Training support workers about the overmedication of people with intellectual disabilities: an Australian pre-post pilot study.

BACKGROUND: There is evidence that psychotropic medications are overprescribed and overused to manage behaviours of concern for people with intellectual disabilities. Disability support workers and support staff lack education and training on the administration and safety of psychotropic medication use. This study aimed to test the applicability and preliminary efficacy of SPECTROM, an education programme developed in the UK, in an Australian context. METHODS: The training comprises two parts: Module 1 encompasses psychotropic medications, their use and side effects. Module 2 focuses on non-pharmacological interventions for supporting people with behaviours of concern. Thirty-three participants attended the training course and completed pre-training and post-training surveys on the Psychotropic Knowledge Questionnaire and Management of Aggression and Violence Attitude Scale-Revised at four time points: pre-training, 2 weeks, 3 months and 5 months post-training. RESULTS: Psychotropic Knowledge Questionnaire scores showed statistically significant post-training improvement at all post-training time points (P < 0.05). Management of Aggression and Violence Attitude Scale-Revised scores were high at pre-training and did not change significantly at any of the post-training survey time points. A 2-week post-training feedback questionnaire reported 80% agreement that the training programme was appropriate, useful and valid. Only 36% of participants completed questionnaires at all time points. CONCLUSIONS: SPECTROM training increased staff knowledge of psychotropic medications, yet loss of participants was high. Further refinement of the applicability of the training for the Australian context and evaluation of the feasibility of implementation, clinical and cost-effectiveness of the programme are required.

Student debt of UK dental students and recent graduates.

Introduction Studies conducted in 2013 estimated the total average debt of UK dental students in their final year. Student tuition fees in the UK have increased over time and maintenance grants abolished. With the current landscape changing, it's important to understand the effect on dental students and the current total debt upon graduation.Aims Quantify the level of debt among dental students graduating in 2021/2022 and the two years prior, understand the impact of debt, and investigate socioeconomic differences.Materials and methods An online survey with final year UK dental students and recent graduates was conducted, resulting in 103 valid responses. The survey design was adapted from a validated British Dental Association (BDA) survey conducted in 2013.Results The mean total debt among respondents was £52,922.12, a substantial increase compared to the BDA data reported in 2013, with commercial and informal loans doubling from 2013 to 2022. Three-in-five (60.2%) experienced financial difficulties during their studies. Significant differences were found among socioeconomic groups.Conclusion Findings from this study show that dental student debt continues to grow, having detrimental impacts on students and their studies, specifically those from lower income households. Interventions should focus on addressing these issues.

Student loans, mental health, and substance use: A gender comparison among US young adults.

Objective: Student loan debt has become a growing crisis. Considering that women are more likely than men to take on student loans and more likely to take on larger amounts, we examine whether the effects of student loans on young adults' mental health and substance use differ by gender. Participants: We used the National Longitudinal Survey of Youth 1997 (NLSY97) data collected from 1997 to 2015. The NLSY97 consists of a nationally representative sample of American youths born between 1980 and 1984. Participants included 2,607 men and 3,004 women who reported college enrollment. Methods: We analyzed data using hybrid regression models. Results: Student loans have more negative effects on young men than young women, in terms of mental health problems, smoking, and heavy drinking. Particularly, young men tend to increase substance use in response to cumulative loan amounts. Conclusions: Borrowing patterns and the health consequences of student loans are gendered.