Exploring factors influencing dental students' negative emotions during a gross anatomy laboratory in Taiwan.

Background/purpose: Negative emotions of medical students during a gross anatomy laboratory are documented in the field of medical education, but those of dental students are relatively less reported in the literature. The purpose of the present study was to explore negative emotions of dental students during the gross anatomy laboratory and possible influential factors. Materials and methods: Basic demographic variables, gross anatomy learning attitudes, and/or life attitudes were collected at five time points among year 2 dental students (n = 49) at a medical university in northern Taiwan. Multi-hierarchical regression analyses were executed to explore possible factors that led to negative emotions. Results: Students who were older, had more-positive attitudes towards life, and had more-positive attitudes towards the anatomy laboratory tended to have weaker negative emotions when they first faced the cadavers. Having a tendency to care about and help people and having a grateful attitude also significantly predicted weaker negative emotions at the middle and end of the semester, respectively. Conclusion: Negative emotions of younger dental students who first encounter a cadaver should be of concern. Striving to improve students' positive attitudes toward life, positive attitudes toward the gross anatomy laboratory, willingness to care about and help people, and an overall grateful attitude may help reduce negative emotions during the gross anatomy laboratory. At an institutional level, integrating educational activities that reduce negative emotions toward cadavers by dental students is highly recommended.

Exploring the impacts of a coffin-lying experience on life and death attitudes of medical and nursing students: preliminary findings.

BACKGROUND: Physicians and nurses often exhibit strong negative emotional and behavioral reactions when patients they care for die, and death education helps them cope with these difficulties. When implementing death education, the literature shows that experiential activities are more effective than lecturing, and progressive exposure is the best way to reduce death anxieties. This study examined the effects of coffin-lying, an activity sometimes seen in Asian cultures, on life and death attitudes of medical and nursing students. METHODS: During a period from 2020 to 2021, 134 medical and nursing students from a medical university in northern Taiwan voluntarily participated in this study. Among them, 53 were in the experimental group, who participated in a coffin-lying activity for nearly 3 hours, and the other 81 were in the control group. All participants filled out questionnaires 1 week before the activity (T1), 1 week after the activity (T2), and 6 ~ 11 weeks after the activity (T3). Three waves of data were analyzed by a repeated-measure multivariate analysis of variance (MANOVA). RESULTS: The effects of "love and care" and "feeling of existence" were only manifested at T2, however, the scores of "fear of death" and "death avoidance" between the experimental and control groups significantly differed at T2 and T3. In addition, there were no significant differences between the experimental and control groups in "neutral acceptance", "approach acceptance", or "escape acceptance". CONCLUSIONS: The coffin-lying activity based on desensitization was effective in improving "fear of death" and "death avoidance", and the effects were sustained to 6 ~ 11 weeks. Coffin-lying is not only a well-designed activity that quickly reduces negative tendencies toward death, but it is also worth adopting by medical and nursing schools to make death education more comprehensive.

Impacts of a gross anatomy laboratory course on medical students' emotional reactions in Taiwan: the role of high-level emotions.

BACKGROUND: Gross anatomy laboratory course at medical school is usually an important learning subject for medical students; however, seeing a cadaver often makes them feel uncomfortable. According to the broaden-and-build theory, positive emotions broaden our inventory of thoughts and actions, and build physical, mental, and social resources. Research on positive psychology found that through direct thanks and positive reframing, people who feel gratitude show fewer depressive symptoms. The present study tried to reduce students' negative emotions towards cadavers by sequential activities, such as family interviews and an initiation ceremony, which induced gratitude and other positive emotions. METHODS: The Emotional Reactions Towards Cadavers Scale (ERTCS) was used to evaluate medical students' emotional reactions after they see a cadaver. Third year medical students (n = 105) at Taipei Medical University in northern Taiwan completed ERTCS on three occasions within a single semester during academic year 2016. Repeated-measures ANOVA and hierarchical regression analyses were then conducted to identify any changes in the emotional reactions of these students. RESULTS: The ERTCS showed satisfactory internal consistency and a three-factor structure, i.e., negative emotions, high-level emotions, and excited emotions. High-level emotions were the highest, and negative emotions were the lowest among the three in our sample. Three-wave data showed that participants' high-level emotions increased, negative emotions decreased, and the former simultaneously predicted the latter after controlling for the influence of gender, religious beliefs, experience of the death of a family member or friend, and burnout level. CONCLUSIONS: While past research usually focused on coping strategies to reduce medical students' negative emotions, our study supported the broaden-and-build theory, which emphasizes positive emotions, and demonstrated that elevating medical students' gratitude to 'silent mentors' is an effective way. It is suggested that combining dissection courses with medical humanities can help students successfully handle negative emotions during a gross anatomy laboratory course.

Effects of a "silent mentor" initiation ceremony and dissection on medical students' humanity and learning.

OBJECTIVES: Many medical schools in Taiwan have adopted a dignified "silent mentor" initiation ceremony to strengthen student's medical humanity and increase their learning attitudes. This ceremony consists of introductions of the body donor's conduct and deeds, wreath-laying, and a tea party. However, few empirical studies have examined the influences of the ceremony and dissection on medical humanity. This study explored if the initiation ceremony and the course can help students care more about others, develop more positive attitudes toward death, improve learning effectiveness in the course, and decrease negative emotions the first time they see a cadaver. METHODS: The Attitudes Towards Death and Love and Care subscales of the life attitude inventory, Learning Effectiveness of Gross Anatomy Laboratory Scale (LEGALS), and Emotional Reactions Towards Cadavers Scale were adopted to examine differences before (T1) and after (T2) medical students attended an initiation ceremony at a university in northern Taiwan. Whether these effects lasted to the end of the semester (T3) was also tested. RESULTS: After the ceremony, students' attitudes towards death increased, negative emotions towards cadavers decreased, but love and care and the LEGALS did not significantly change. Data from T3 showed a similar pattern, but high-level emotions (e.g., being respected, cherished, and grateful) and the LEGALS were significantly higher than those at T1. DISCUSSION: The initiation ceremony, which showed a body donor's deeds and attitudes toward life and death when they were alive, could help medical students gain more mature attitudes towards death and decreased negative emotions. Learning between T2 and T3 might have caused significant changes in high-level emotions and the LEGALS at T3. Arranging reflective writing with guided discussion by a teacher before and after the ceremony is highly recommended.

Analysis of the barriers of mental distress disclosure in medical inpatients in Taiwan.

BACKGROUND: Disclosure of mental distress to physicians is important for mental illness identification, early referrals and proper treatment to prevent suicide. Little is known about what affects mental health communication in the clinical settings in the Chinese societies. AIMS: The study aimed to identify the demographic, psychosocial and medical factors related to people with non-disclosure of their mental distress. METHODS: We interviewed a series of consecutive inpatients from two medical wards of a general hospital in northern Taiwan. We collected depressive symptoms (the Patient Health Questionnaire, PHQ-9), living arrangement, threatening life events, suicide risks (i.e. past self-harm history, lifetime suicide ideas and hopelessness) and recent experience of mental distress disclosure. Furthermore, we explored the reasons of non-disclosure. RESULTS: A total of 230 medical inpatients agreed to participate (53.5% males). The results indicated that only 5.7% actually communicated their mental health concerns, and that 12.3% were willing to talk about their mental health problems. Among the 69 (30%) depressed participants (PHQ-9 score ≥ 10 points), the disclosure rate was low (8.7%) and the wish to talk about mental distress was also low (10.3%). After adjustment, living alone (OR = 7.58, 95% CI = 1.56-36.91) and having stressful life events (OR = 3.68, 95% CI = 1.09-12.46) remained significant in predicting disclosure of mental distress. The 109 participants attributed their refusal of communicating mental distress as medical-related attributes, subjective perceptions or sociocultural factors. CONCLUSION: Communication of mental distress in medical settings was uncommon due to medical or psychosocial barriers in Taiwan. Skill training to facilitate disclosure in medical education and public campaigns to improve knowledge of depression and enhance help-seeking deserve more attention, particularly under the influence of stigma in the Chinese societies.

Reducing the stigma of depression through neurobiology-based psychoeducation: a randomized controlled trial.

AIMS: Attribution theory claims that people who are stigmatized experience more negative emotional and behavioral reactions from others when they are thought to be responsible for their problems. Accordingly, this study proposed a neurobiology-based psychoeducational intervention, which attempted to reduce people's blameworthy attitudes toward and social distance from depressed individuals. METHODS: One hundred and thirty-two college students were randomly assigned to an experimental and control group. Participants in the experimental group received a 30-min lecture on neurobiology-based psychoeducation for depressive disorders, and were asked to fill out questionnaires before and 2 weeks after the intervention. The control group, with no intervention, also filled out the same questionnaires before and 2 weeks after the experiment. The main contents of the neurobiology-based psychoeducation concerned the neurotransmission processes and biological mechanisms of depression, in order to emphasize the biological attribution of depression. RESULTS: An ancova indicated that the neurobiology-based psychoeducational intervention significantly elevated the biological attribution of depression and reduced the social distance from depressed individuals. Psychological blameworthy attitudes toward depression, however, did not significantly change. CONCLUSIONS: Through a brief psychoeducation program about depression, knowledge of neuroscience could lead to positive benefits. Public awareness that depression can be effectively prevented and treated may be a way in which people can accept depressed individuals. Further studies are needed to certify the mechanisms of the effect of neurobiology-based psychoeducation.

Effects of psychoeducation for depression on help-seeking willingness: biological attribution versus destigmatization.

Existing literature shows that the level of biological attribution and stigma of depression influences willingness to seek help. However, no study has used experimental methods to explore the question whether increasing biological attribution and decreasing blameworthy attitude towards depression will enhance willingness to seek help. In so doing, 299 college students were randomly assigned to biological, destigmatization, combined, and control groups. The measures included the Biological Attribution Scale, Psychological Blame Scale, and Help-Seeking Willingness Scale. The data were analyzed by a 2 x 2 ancova (with or without biological attribution education x with or without destigmatization education) on willingness to seek professional help which was assessed 2 weeks later, with adjusting for help-seeking willingness at baseline. Results showed that biological education had a significant main effect to elevate help-seeking willingness, but destigmatization education did not. In addition, no interaction effect existed between the two independent variables. The authors suggested that biological education makes people legitimize depression as a disease entity, so that it would be a practical approach to increase people's motivation to solve their emotional afflictions, especially in societies that emphasize emotional constraints. In contrast, although destigmatization information reduces people's negative appraisals to the depressed individuals, it does not go a step further to increase people's motivation to seek professional help. Further studies are needed to clarify the mechanisms of educational effects.