[Planetary Health in the mandatory undergraduate medical curriculum - A qualitative study to evaluate a teaching/learning intervention]. / Planetary Health in der curricularen Lehre im Fach Humanmedizin ­ eine qualitative Studie zur Evaluation einer Lehr-/Lernintervention.

INTRODUCTION: Climate change is the greatest threat to human health and therefore has a direct impact on the work of physicians. At the same time, the health sector is also an originator of pollutants that burden the climate. The concept of Planetary Health describes, among other things, ways in which the health sector can counter the effects of climate change. Nevertheless, the inclusion of contents on sustainable action in the education of health professionals has not been made mandatory to date. The aim of this study is to answer the question of how an intervention has to be designed so that medical students specifically develop an interest in dealing with the topic on their own. METHODS: The intervention consisted ofFor evaluation purposes, a qualitative study with guided focus group interviews of attendees was conducted. The fully transcribed focus group transcripts were analysed using Mayring's structuring qualitative content analysis. Additionally, we checked the semester evaluation for feedback on the intervention. RESULTS: Four focus groups comprising n = 14 medical students (11 female, 3 male) were conducted. Dealing with Planetary Health as a topic during medical education was considered relevant. The partially restrained to negative reaction of the teaching practice staff involved to the checklist had a demotivating effect. A lack of time was given as a further reason for not dealing with the topic independently. Participants suggested integrating specific Planetary Health content in mandatory courses and considered environmental medicine to be especially suited. As a didactic method, case-based working in small groups seemed to be particularly appropriate. In the semester evaluation, we found both approving and critical commentaries. DISCUSSION: Participants considered Planetary Health a relevant topic in the context of medical education. The intervention proved to be of limited use in motivating students to deal with the topic independently. A longitudinal integration of the topic in the medical curriculum seems to be appropriate. CONCLUSIONS: From the students' perspective, it is important to teach and acquire knowledge and skills regarding to Planetary Health in the future. Despite a high level of interest, additional offers are not being utilised due to a lack of time and should therefore be made part of the mandatory curriculum, where possible.

Medical students' coping with stress and its predictors: a cross-sectional study.

Objectives: To analyse stress coping styles of medical students at different time points of medical education and to identify predictors of functional coping. Methods: A cross-sectional study was conducted among medical students (N = 497, 361 women and 136 men) before year one (n = 141), after year one (n = 135) and after year five (n = 220). Students answered the Brief Coping Orientation to Problems Experienced Inventory, the Work-Related Behaviour and Experience Patterns, the Perceived Medical School Stress Instrument and the Maslach Burnout Inventory. Multiple regression was used to examine factors associated with functional coping. Results: Single factor ANOVA indicated a significant difference for functional coping between the time points (F (2, 494) = 9.52, p < .01), with fifth-year students scoring significantly higher than students before or after year one. There was a significant difference in dysfunctional coping (F (2, 494) = 12.37, p < .01), with students before year one and after year five scoring higher than those after year one. Efficacy (ß = 0.15, t (213) = 4.66, p < .01), emotional distancing (ß = 0.04, t (213) = 3.50, p < .01) and satisfaction with life (ß = 0.06, t (213) = 4.87, p < .01) were positive predictors of functional coping. Conclusions: Scores for both functional and dysfunctional coping vary during medical education. The reasons for low coping scores after year one require further explanation. These findings represent a starting point for investigations into how to promote functional coping during early medical education.

The predictive validity of admission criteria for the results of clinical competency assessment with an emphasis on family medicine in the fifth year of medical education: an observational study.

BACKGROUND: In many countries, the number of applicants to medical schools exceeds the number of available places. This offers the need, as well as the opportunity to medical schools to select those applicants most suitable for later work as a doctor. However, there is no generally accepted definition of a 'good doctor'. Clinical competencies may serve as surrogates. The aim of this study was to compare medical students in Germany selected based either on their pre-university grade point average alone or based on the result of a university-specific selection procedure regarding their clinical competencies with an emphasis on family medicine in the later years of training. METHODS: We used the 'Allgemeinarztbarometer Ausbildung' (Undergraduate Family Medicine Barometer), an instrument developed to assess clinical competencies with an emphasis on family medicine, to compare students in the pre-university grade point average admission-quota and the university-specific selection procedure admission-quota in the fifth year of training. Students were judged by their supervising general practitioners after a two-week practical course. Competencies were rated on a five-point Likert-scale (1 = 'totally agree' i.e. the student is very competent to 5 = 'totally disagree' i.e. the student is not competent at all). RESULTS: We included 94 students (66% female). Students in the university-specific selection procedure quota (n = 80) showed better mean scores in every item of the Undergraduate Family Medicine Barometer. We found a statistically significant difference between the two groups for the item assessing communication skills (M [university-specific selection procedure quota] = 1.81, SD = 0.84 vs. M [pu-GPA quota] = 2.38, SD = 0.96; t[91] = -2.23, p = .03; medium effect size). Logistic regression revealed no statistically significant age or gender contribution. CONCLUSIONS: Despite the small sample-size, our results indicate, that students selected via an university-specific selection procedure show better communicative competencies in the later years of training.

[Experiences with Video-Based Assessment under Pandemic-Related Contact Restrictions]. / Erfahrungen mit videobasiertem Assessment in Zeiten pandemiebedingter Kontaktbeschränkungen.

Background: Due to the COVID-19 pandemic, the Objective Structured Clinical Examination (OSCE) examinations were cancelled in the short term. This project described how to offer medical students an alternative assessment at Miller's competence level of "shows how". Methods: Students produced videos in which they can be seen performing various physical examinations related to family medicine consultations. Trained assessors rated the videos uploaded to the learning platform and gave verbal feedback if requested. Results: The grading (65 "very good" and 38 "good") was very mild. Twelve per cent of the students requested verbal feedback. Their evaluation of the procedure was mixed. The evaluators consistently assessed their task and the process as positive. Technically, the video-based assessment could be implemented without any problems. Conclusions: The short-term implementation of a video-based assessment in the context of medical education proved to be feasible. It could serve not only as an emergency solution under a pandemic, but also as an additional opportunity for formative feedback in the future.

Stress and behavior patterns throughout medical education - a six year longitudinal study.

BACKGROUND: Medical education has a reputation for being demanding and stressful. However, longitudinal surveys across the whole course of study considering risks and resources are rare. METHODS: For the evaluation of stress and coping we administered the standard instruments Perceived Medical School Stress Scale (PMSS), Hospital Anxiety and Depression Scale (HADS), Work-Related Behavior and Experience Patterns (AVEM), Maslach Burnout Inventory (MBI), and a short form of the Coping Orientations to Problems Experienced Scale (Brief COPE) in three consecutive cohorts of medical students (N = 377) at one German university. Students were surveyed at the beginning of their studies (t0) and again during each consecutive summer semester (t1-t6). RESULTS: Stress and symptoms of anxiety and depression increased in the first two years of medical studies but decreased again towards their end. Consistently, freshmen medical students presented with a large proportion of the healthy pattern at t0 (56 %) that decreased to 30 % at t2, and increased up to 44 % at t6. Correspondingly, the proportion with the burnout-related risk pattern B increased from 9 to 16 % at t2, again decreasing to 7 % at t6. Over the whole course of study there was an almost continuous increase of the unambitious pattern S from t0 13 to 40 % at t6. Characteristic differences especially between the healthy pattern and the risk patterns regarding stress, mental health symptoms and coping were observed. Female students showed a higher vulnerability for stress, anxiety and depression as well as lower proportions with a healthy pattern, and higher proportions with risk patterns for overexertion and burnout. CONCLUSIONS: The development of stress, symptoms and behavior and experience patterns especially in the first two years, demonstrating increasing study-related stress in the preclinical years, as well as the high proportion with an unambitious pattern at the end of the course of study emphasize the need for prevention and health promotion at both the individual and contextual levels.

The Development of Empathy and Associated Factors during Medical Education: A Longitudinal Study.

PURPOSE: In this longitudinal study, we investigated the development of empathy during medical education and assessed potential predictors of empathy at different time points in the course of medical studies. METHODS: In our longitudinal study, starting in 2011, we surveyed medical students at Lübeck Medical School, Germany at the beginning of their course of study and after 2, 4, and 6 years (t0-t3) using standard instruments for empathy (Jefferson Scale of Empathy, Student Version, JSE-S), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), stress (Perceived Medical School Stress scale), and behavior and experience patterns (Arbeitsbezogene Verhaltens- und Erlebensmuster [Work-related Behavior and Experience Patterns]). RESULTS: A total of 43 students completed all surveys. The cross-sectional samples for the different survey time points comprised between n = 220 and 658 students. We observed a slight, but statistically significant, increase of empathy scores from t0 to t3 (t(43) = -3.09, P < .01). Across all analyses, a preference for a people-oriented specialty was associated with a higher JSE-S sum score, as well as being female, whereas we saw a negative association between HADS depression and JSE-S scores. CONCLUSION: In our study, empathy scores were shown to be relatively stable during medical education with a tendency to increase. In line with previous research, individuals preferring a people-oriented specialty and women showed higher empathy scores.

The impact of the COVID-19 pandemic on stress, mental health and coping behavior in German University students - a longitudinal study before and after the onset of the pandemic.

BACKGROUND: The COVID-19 pandemic has led to massive restrictions in public and private lives, including a shut-down of face-to-face teaching at universities in Germany. We aimed to examine the impact of these changes on perceived stress, mental health and (study-)related health behavior of students in a longitudinal study. METHODS: For two timepoints - the year before the COVID-19 pandemic (2019, n = 1377) and the year during the COVID-19 pandemic (2020, n = 1867) - we surveyed students of all faculties at one German university for perceptions and preventive behavior regarding the COVID-19 pandemic using standard instruments for stress, anxiety, depression, and behavior and experience patterns. RESULTS: About 90% of students (n = 1633) in 2020 did not have a known contact infected with SARS-CoV-2, while 180 (9.8%) did have one. Only 10 respondents (0.5%) reported an infection with SARS-CoV-2. Wearing masks and washing hands more often were practiced by ≥80% of students. Taking more care about cleanliness (51.8%) and using disinfectants (39.2%) were practiced much less. A higher percentage of female compared with male students and medical/health science students compared with science, technology, engineering, and mathematics students engaged more frequently in specific or nonspecific preventive measures. More than three quarters (77.1%) of all students rated their general health as (very) good. There were no significant differences in general health, stress, and depression between 2019 and 2020 in the students who responded at both timepoints. The distribution of behavior and experience patterns for this group showed a slight but significant difference from 2019 to 2020, namely decreasing proportions of students with a healthy pattern and a risk pattern for overexertion. Students with different behavior and experience patterns showed marked differences in perceptions and reaction to the COVID-19 pandemic as well as psychosocial stress and symptoms, with higher scores for mental health symptoms and lower scores in preventive behavior regarding risk patterns. CONCLUSION: Despite massive alterations to students' lives in 2020, there were only moderate consequences for mental health compared with 2019 in the total student group of this German university. However, identifying students at risk would offer opportunities to foster mental health in relevant subgroups.

Approaches of integrating the development of guidelines and quality indicators: a systematic review.

BACKGROUND: Guidelines and quality indicators (for example as part of a quality assurance scheme) aim to improve health care delivery and health outcomes. Ideally, the development of quality indicators should be grounded in evidence-based, trustworthy guideline recommendations. However, anecdotally, guidelines and quality assurance schemes are developed independently, by different groups of experts who employ different methodologies. We conducted an extension and update of a previous systematic review to identify, describe and evaluate approaches to the integrated development of guidelines and related quality indicators. METHODS: On May 24th, 2019 we searched in Medline, Embase and CINAHL and included studies if they reported a methodological approach to guideline-based quality indicator development and were published in English, French, or German. RESULTS: Out of 16,034 identified records, we included 17 articles that described a method to integrate guideline recommendations development and quality indicator development. Added to the 13 method articles from original systematic review we included a total 30 method articles. We did not find any evaluation studies. In most approaches, guidelines were a source of evidence to inform the quality indicator development. The criteria to select recommendations (e.g. level of evidence or strength of the recommendation) and to generate, select and assess quality indicators varied widely. We found methodological approaches that linked guidelines and quality indicator development explicitly, however none of the articles reported a conceptual framework that fully integrated quality indicator development into the guideline process or where quality indicator development was part of the question formulation for developing the guideline recommendations. CONCLUSIONS: In our systematic review we found approaches which explicitly linked guidelines with quality indicator development, nevertheless none of the articles reported a comprehensive and well-defined conceptual framework which integrated quality indicator development fully into the guideline development process.

[The "Allgemeinarztbarometer A" - an instrument to assess primary care competencies during medical education and training]. / Das Allgemeinarztbarometer A ­ ein Instrument zur Erhebung von primärärztlichen Kompetenzen in der medizinischen Ausbildung.

INTRODUCTION: The primary goal of medical education and training is to develop clinical competencies. Competency-based curricula exist for both medical education which - once the current reform is implemented - will be geared more towards primary care, and specialty training for General Practice. The "Allgemeinarztbarometer" is a German-language instrument to assess primary care competencies during specialty training and has so far been mainly used as a self-assessment tool. The aim of this study was (i) to test the application of the "Allgemeinarztbarometer" in the context of medical education as an external assessment tool (in its "Allgemeinarztbarometer A [ABA]" version) and (ii) to evaluate its basic psychometric properties. METHODS: Physicians involved in teaching were asked to assess medical students after a two-week internship in General Practice during their fifth year of study using the ABA (9-item external assessment version). After data processing and displaying basic distributions, we conducted exploratory factor analysis, followed by confirmatory factor analysis. The detected factor structure was then tested for internal consistency. RESULTS: A total of 150 completed questionnaires were included in the analysis. One item showed a high number of missing values (response option "Not assessable"). Exploratory factor analysis indicated a two-factor structure ("Patient-oriented skills" and "General Practice decision-making"). Three items were not unambiguously assignable and hence erased. Confirmatory factor analysis validated the identified factor structure. The two factors showed a Cronbach's α of 0.73 and 0.84 (moderate to very good internal consistency). DISCUSSION: Our study provides a first analysis of the ABA in the context of medical education. The detected two-dimensional structure shows a high goodness-of-fit when giving up three items still used in this survey. The analysis of missing data showed a high number of "I can't say" answers when assessing the development of strategies against burnout. CONCLUSIONS: The ABA (6-item version) seems to be a suitable tool for the external assessment of General Practice competencies in the context of medical education. Further studies are needed to evaluate both the completeness of the assessment and the external assessability of certain items in the context of medical education.

Do Medical Students in Their Fifth Year of Undergraduate Training Differ in Their Suitability to Become a "Good Doctor" Depending on Their Admission Criteria? A Pilot Study.

BACKGROUND: In Germany, the pre-university grade point average (pu-GPA) has to be the main criterion for medical school applicant selection. This is also mandatory in the university-specific selection procedures (Auswahlverfahren der Hochschulen [AdH]). The admission framework has now been reworked following a judgement by the German Federal Constitutional Court. From 2020, more students will be admitted based solely on the pu-GPA and at least two selection criteria independent of the pu-GPA have to be considered in the AdH. However, the question whether an AdH (the core of the AdH at Lübeck Medical School [LMS], Germany, is a 30-mins panel interview led by two faculty members and one student) leads to better doctors as compared to pu-GPA-based selection, remains unanswered. OBJECTIVE: To compare students selected based either on their pu-GPA alone ("pu-GPA-students") or based on the result of the AdH at LMS ("AdH-students") regarding their suitability to become a good doctor. DESIGN: We conducted a cross-sectional observational pilot study at LMS. Students were judged regarding their overall suitability to become a good doctor by their supervising general practitioners after a two-week internship in their last year of theoretical medical education. The scores were matched to the selection procedure and compared between the pu-GPA-students and AdH-students. RESULTS: In all, 79% of the AdH-students were rated as "absolutely suitable" for the medical profession, as compared to 42% of the pu-GPA-students (p = 0.01, odds ratio 5.17, 95% confidence interval = 1.41, 18.99). We did not find any association between gender or age and the suitability rating. CONCLUSION: Despite the small sample size, our results indicate that it could be favourable to select medical students not only based on their pu-GPA but also using additional selection criteria.

Study-related behavior patterns of medical students compared to students of science, technology, engineering and mathematics (STEM): a three-year longitudinal study.

BACKGROUND: Medical education is perceived as demanding and stressful. Whether this is particularly pronounced in this course of study remains under debate. METHODS: We used the questionnaire "Work-Related Behavior and Experience Patterns (Arbeitsbezogene Verhaltens- und Erlebensmuster (AVEM))" to assess the development of study-related behavior and experience patterns in medical (n = 584) and STEM students (n = 757) at one German university, with a special emphasis on gender differences, over 3 years of study. Students were surveyed at the beginning of their studies (t0) and again in each consecutive summer semester (t1-t3). Both cross-sectional and longitudinal data were generated and analyzed. Results in the abstract are from the cross-sectional analysis. RESULTS: Freshman medical students presented with a larger proportion of students with a healthy pattern (58.1%) than STEM students (42.5%). In both groups this proportion decreased to 33.8%/25.1% at t2, with only a minor improvement at t3 (38.1/27.0%). Correspondingly, the proportion of students with a burnout-related risk pattern increased from 8.0% (Med)/13.7% (STEM) to a maximum of 16.9% at t2 in medical students and 27.0% at t3 in STEM students. In both groups female students showed a more unfavorable distribution of patterns and a higher vulnerability, especially in the area of resistance toward stress. CONCLUSIONS: The unfavorable development of behavior and experience patterns in both student groups demonstrates increasing study related stress and emphasizes the need for prevention and health promotion on an individual and a contextual level.

What keeps medical students healthy and well? A systematic review of observational studies on protective factors for health and well-being during medical education.

BACKGROUND: Despite the growing evidence of a negative impact of medical school on students' health and well-being, little is known about protective factors for staying healthy and well during medical education. Therefore, a systematic review of peer-reviewed studies aiming to identify such predictors was conducted. METHODS: Medline, Embase, and PsychInfo were systematically searched by using preselected MeSH terms to identify English- and German-language peer-reviewed articles (observational studies) examining predictors for medical students' health and well-being, published between January 2001 and April 2018. Two authors independently selected abstracts reporting predictors for medical students' health and well-being. Further, two authors extracted information from the identified studies, needed for methodological quality assessment of the studies, as well as for comprehensive description of identified predictors. RESULTS: From 5013 hits in the database search, six observational studies met the inclusion criteria and were included in the final analysis. These studies were of heterogeneous design and quality. They featured a wide variety of health and well-being related outcomes and of its predictors. Lower levels of perceived stress, as well as lower levels of neuroticism were found to predict better health-related outcomes. CONCLUSIONS: Further research, by using harmonized tools for the assessment of outcomes, as well as predictors, is needed to determine what keeps students healthy and well during medical education. Identifying protective factors is an essential prerequisite for the design of evidence-based health-promoting interventions.

[Starting points for resilience promotion in medical education: What keeps future doctors healthy?] / Ansatzpunkte für Resilienzförderung im Medizinstudium ­ Was hält angehende Ärztinnen und Ärzte gesund?

A trend towards reduced resilience to stress and impaired psychosocial well-being begins early on in medical education. Our own results confirm the early deterioration of the psychosocial health of medical students observed internationally. Students who simultaneously demonstrate high levels of perfectionism, an insufficient ability to distance themselves from work, as well as a lack of regular physical activity appear to form a special risk group. Therefore, it seems rational to implement interventions that counteract this development by enhancing individual resources and preventing harmful curriculum-associated influences as early as possible during medical education. Interventions should target both individual behaviour and experience patterns of students as well as the setting. The medical curriculum itself was viewed as a priority starting point for resilience-promoting interventions by the students. It should be in the interest of all parties involved to enable all students to stay well during their medical education and to provide them with resources for their work like, e. g. good resilience, which, in turn, will have a sustainable positive effect on the quality of patient care. To date, the evidence base with regard to protective factors for medical students' health and effective resilience-promoting interventions is insufficient in terms of quantity and quality. Moreover, there are only a few meaningful studies that deal specifically with German-speaking areas. Our own studies show that the willingness to participate in resilience-promoting interventions is high in spite of the additional expenditure of time because students consider such interventions to be helpful. Interventions employing the concepts of Mind Body Medicine seem to be especially promising in the context of medical education.

Perceived Medical School stress of undergraduate medical students predicts academic performance: an observational study.

BACKGROUND: Medical students are exposed to high amounts of stress. Stress and poor academic performance can become part of a vicious circle. In order to counteract this circularity, it seems important to better understand the relationship between stress and performance during medical education. The most widespread stress questionnaire designed for use in Medical School is the "Perceived Medical School Stress Instrument" (PMSS). It addresses a wide range of stressors, including workload, competition, social isolation and financial worries. Our aim was to examine the relation between the perceived Medical School stress of undergraduate medical students and academic performance. METHODS: We measured Medical School stress using the PMSS at two different time points (at the end of freshman year and at the end of sophomore year) and matched stress scores together with age and gender to the first medical examination (M1) grade of the students (n = 456). RESULTS: PMSS scores from 2 and 14 months before M1 proved to be significant predictors for medical students' M1 grade. Age and gender also predict academic performance, making older female students with high stress scores a potential risk group for entering the vicious circle of stress and poor academic performance. CONCLUSIONS: PMSS sum scores 2 and 14 months before the M1 exam seem to have an independent predictive validity for medical students' M1 grade. More research is needed to identify potential confounders.

Are the results of questionnaires measuring non-cognitive characteristics during the selection procedure for medical school application biased by social desirability?

Introduction: A stronger consideration of non-cognitive characteristics in Medical School application procedures is desirable. Psychometric tests could be used as an economic supplement to face-to-face interviews which are frequently conducted during university internal procedures for Medical School applications (AdH, Auswahlverfahren der Hochschulen). This study investigates whether the results of psychometric questionnaires measuring non-cognitive characteristics such as personality traits, empathy, and resilience towards stress are vulnerable to distortions of social desirability when used in the context of selection procedures at Medical Schools. Methods: This study took place during the AdH of Lübeck University in August 2015. The following questionnaires have been included: NEO-FFI, SPF, and AVEM. In a 2x1 between-subject experiment we compared the answers from an alleged application condition and a control condition. In the alleged application condition we told applicants that these questionnaires were part of the application procedure. In the control condition applicants were informed about the study prior to completing the questionnaires. Results: All included questionnaires showed differences which can be regarded as social-desirability effects. These differences did not affect the entire scales but, rather, single subscales. Conclusion: These results challenge the informative value of these questionnaires when used for Medical School application procedures. Future studies may investigate the extent to which the differences influence the actual selection of applicants and what implications can be drawn from them for the use of psychometric questionnaires as part of study-place allocation procedures at Medical Schools.

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.

Resource-oriented coaching for reduction of examination-related stress in medical students: an exploratory randomized controlled trial.

INTRODUCTION: The years spent in acquiring medical education is considered a stressful period in the life of many students. Students whose mental health deteriorates during this long period of study are less likely to become empathic and productive physicians. In addition to other specific stressors, academic examinations seem to further induce medical school-related stress and anxiety. Combined group and individual resource-oriented coaching early in medical education might reduce examination-related stress and anxiety and, consequently, enhance academic performance. Good quality evidence, however, remains scarce. In this study, therefore, we explored the question of whether coaching affects examination-related stress and health in medical students. METHODS: We conducted a randomized controlled trial. Students who registered for the first medical academic examination in August 2014 at the University of Lübeck were recruited and randomized into three groups. The intervention groups 1 and 2 received a 1-hour psychoeducative seminar. Group 1 additionally received two 1-hour sessions of individual coaching during examination preparation. Group 3 served as a control group. We compared changes in self-rated general health (measured by a single item), anxiety and depression (measured by the hospital anxiety and depression scale), as well as medical school stress (measured by the perceived medical school stress instrument). In order to further investigate the influence of group allocation on perceived medical school stress, we conducted a linear regression analysis. RESULTS: We saw a significant deterioration of general health and an increase in anxiety and depression scores in medical students while preparing for an examination. We found a small, but statistically significant, effect of group allocation on the development of perceived medical school stress. However, we could not differentiate between the effects of group coaching only and group coaching in combination with two sessions of individual coaching. CONCLUSION: The health of medical students deteriorated while preparing for an examination. Short-term resource-oriented coaching might be an effective means of reducing medical school stress in candidates preparing for an examination.

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

CONTEXT: 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. OBJECTIVES: This study was designed to investigate: (i) how the health of medical students develops over the freshman year, and (ii) whether certain protective factors can predict general and mental health status after 1 year of medical education. METHODS: A prospective, longitudinal, observational study was conducted at one medical school. Self-rated general and mental health status before and after the freshman year were used as outcomes. In addition to socio-demographic variables and leisure activities, personality and study-related behaviour and experience were surveyed as potential predictors. Both descriptive techniques and logistic regression analyses were employed to identify predictors for general and mental health separately. RESULTS: At baseline, 93% of medical students rated their general health and 88% rated their mental health as good. These frequencies declined over the first year to 76% and 84%, respectively. For general health, regular physical activity was the strongest predictor (odds ratio [OR] 4.58). Satisfaction with life (OR 1.18) and balance and mental stability (OR 1.20) emerged as positive predictors, and age (OR 0.85) and striving for perfection (OR 0.76) as negative predictors. Mental health status was predicted by emotional distancing (OR 1.25), experience of social support (OR 0.73), neuroticism (OR 0.89) and age (OR 0.85). CONCLUSIONS: Self-rated general and mental health declined throughout the first year of medical education. Physical activity proved to be a strong predictor for the maintenance of good general health. This finding may represent a starting point for health-promoting interventions, such as the provision of time slots for physical activity.

Stressors and starting points for health-promoting interventions in medical school from the students' perspective: a qualitative study.

INTRODUCTION: Medical education is considered very challenging and connected with high levels of psychosocial stress for students. The aim of this study was to identify stressors and possible starting points for health-promoting interventions from the perspective of the students themselves. METHODS: We conducted two focus groups with medical students from pre-clinical and clinical semesters. We analyzed the data using content analysis following Mayring's approach. RESULTS: The stressors in the pre-clinical stage of medical education were more diverse and perceived as more intense than those in the clinical stage. They comprised contextual factors and individual behaviour. Participants mentioned the weekly examinations as a specific stressor. The existing absence regulations gave the participants the impression that they should not be absent through illness at any point during the course, and this idea further promoted presenteeism. Peer groups and mentoring programmes were perceived as helpful. CONCLUSIONS: Stressors and starting points for health-promoting interventions are closely related to the medical curriculum and its organization. As such, the curriculum itself-in addition to programmes aimed at improving stress management-should primarily stand at the centre of activities for enhancing students' health.

Metamizole-associated adverse events: a systematic review and meta-analysis.

BACKGROUND: Metamizole is used to treat pain in many parts of the world. Information on the safety profile of metamizole is scarce; no conclusive summary of the literature exists. OBJECTIVE: To determine whether metamizole is clinically safe compared to placebo and other analgesics. METHODS: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and several clinical trial registries. We screened the reference lists of included trials and previous systematic reviews. We included randomized controlled trials that compared the effects of metamizole, administered to adults in any form and for any indication, to other analgesics or to placebo. Two authors extracted data regarding trial design and size, indications for pain medication, patient characteristics, treatment regimens, and methodological characteristics. Adverse events (AEs), serious adverse events (SAEs), and dropouts were assessed. We conducted separate meta-analyses for each metamizole comparator, using standard inverse-variance random effects meta-analysis to pool the estimates across trials, reported as risk ratios (RRs). We calculated the DerSimonian and Laird variance estimate T2 to measure heterogeneity between trials. The pre-specified primary end point was any AE during the trial period. RESULTS: Of the 696 potentially eligible trials, 79 trials including almost 4000 patients with short-term metamizole use of less than two weeks met our inclusion criteria. Fewer AEs were reported for metamizole compared to opioids, RR = 0.79 (confidence interval 0.79 to 0.96). We found no differences between metamizole and placebo, paracetamol and NSAIDs. Only a few SAEs were reported, with no difference between metamizole and other analgesics. No agranulocytosis or deaths were reported. Our results were limited by the mediocre overall quality of the reports. CONCLUSION: For short-term use in the hospital setting, metamizole seems to be a safe choice when compared to other widely used analgesics. High-quality, adequately sized trials assessing the intermediate- and long-term safety of metamizole are needed.