The relationship between Empathy and listening styles is complex: implications for doctors in training.

BACKGROUND: Effective communication is the key to a successful relationship between doctors and their patients. Empathy facilitates effective communication, but physicians vary in their ability to empathize with patients. Listening styles are a potential source of this difference. We aimed to assess empathy and listening styles among medical students and whether students with certain listening styles are more empathetic. METHODS: In this cross-sectional study, 97 medical students completed the Jefferson scale of Empathy (JSE) and the revised version of the Listening Styles Profile (LSP-R). The relationship between empathy and listening styles was assessed by comparing JSE scores across different listening styles using ANOVA in SPSS software. A p-value less than 0.05 was considered significant. RESULTS: Overall, the students showed a mean empathy score of 103 ± 14 on JSE. Empathy scores were lower among clinical students compared to preclinical students. Most of the medical students preferred the analytical listening style. The proportion of students who preferred the relational listening style was lower among clinical students compared to preclinical students. There was no significant relationship between any of the listening styles with empathy. CONCLUSION: Our results do not support an association between any particular listening style with medical students' empathic ability. We propose that students who have better empathetic skills might shift between listening styles flexibly rather than sticking to a specific listening style.

I didn't want to remember memories of caring, but I can't help it": A qualitative study of the experiences of bereaved Iranian carers with elevated levels of prolonged grief symptoms.

The lived experience of caring for people with cancer and the influence of culture on Iranian carers who have elevated levels of prolonged grief symptoms after the death has received little in-depth attention. Bereaved carers (N = 17) were interviewed. All showed high levels of prolonged grief symptoms. Thematic analysis resulted in four overarching themes: unfamiliarity with cancer, high involvement in carer's role, lack of processing events, and emptiness. The way that carers of cancer patients understand and cope with their caring role and their dominant cultural context can make their grieving process complex.

Using multiple self-regulated learning measures to understand medical students' biomedical science learning.

CONTEXT: Understanding self-regulated learning (SRL) is complicated due to the different measures used to identify the key SRL processes. There is a growing trend in applying event measures of SRL (microanalysis and trace) but aptitude measures (questionnaires) continue to be widely used in medical education. A major concern is whether aptitude measures are a valid approach to capture the dimensions of SRL processes. This study examined correlations between SRL microanalysis, SRL trace and the Motivated Strategies for Learning Questionnaire (MSLQ) and how these measures were associated with biomedical science performance. METHODS: An SRL microanalysis assessment interview was administered to 76 first-year medical students individually when performing a biomedical science learning task. All written materials by students were collected for further trace analysis. Students completed an MSLQ 2 weeks before completing their biomedical science course. Correlation analyses were used to determine the correlations between the three SRL assessment measures. Bivariate and multiple analyses were conducted to compare students on different course or task performance using the three SRL assessment measures. RESULTS: Microanalytic metacognitive monitoring (κ = 0.30, P < .001) and causal attributions (κ = 0.17, P = .009) had statistically significant correlations with use of the SRL trace strategy. MSLQ self-efficacy correlated with microanalytic self-efficacy (r = .39, P = .001). Bivariate tests showed that microanalytic metacognitive monitoring, causal attributions and adaptive inferences, and SRL trace strategy use had significant associations with task performance (P < .05). Microanalytic self-efficacy, metacognitive monitoring and causal attributions, SRL trace strategy use and MSLQ self-efficacy had significant associations with course performance (P < .05). Measures of use of the SRL trace strategy and MSLQ subscales did not show significant associations with task and course outcomes in multiple analyses (P > .05). CONCLUSIONS: Event measures, specifically SRL microanalysis, had greater associations with both task and course outcomes compared with the MSLQ measure. The SRL microanalysis is recommended for the assessment of SRL in biomedical science learning. However, to fully understand medical students' SRL a multidimensional assessment approach that combines event and aptitude measures should be used.

Psychometric properties of Persian version of Cognitive Behavioural Avoidance Scale: results from student, general population and clinical samples in Iran.

BACKGROUND: There is no published evidence about the psychometric properties of the Cognitive Behavioral Avoidance Scale (CBAS) in Eastern cultures. AIMS: The current research evaluated the psychometric properties of a Persian version of the CBAS. METHOD: The research consisted of two studies. In Study 1, a university student sample (n = 702) completed the CBAS, the Beck Depression Inventory-II, the Thought Control Questionnaire and the Anxious Thoughts Inventory. In Study 2, a general population sample (n = 384) and a clinical sample (n = 152) completed the CBAS, the Young Compensation Inventory and the Depression, Anxiety, Stress Scale-21. RESULTS: Exploratory factor analysis of the data from Study 1 suggested a four-factor solution for CBAS. The CBAS had acceptable internal consistency and test-re-test reliability, and showed significant correlations with depression symptoms and anxious thoughts. Confirmatory factor analysis of the data from Study 2 indicated good fit between the four-factor model and data. The CBAS had a significant relationship with depression, anxiety and stress symptoms, but no associations with schema compensatory behaviour strategy. Finally, the CBAS and its subscales successfully distinguished a clinical sample from a general population sample. CONCLUSIONS: The findings provide preliminary evidence for reliability and validity of the CBAS among Iranian student, general population and clinical samples.

Integrating behavioral and social sciences components into a competency-based MD program curriculum: A qualitative study on opinions of faculty members.

Background: Behavioral, social, psychological and biological factors influence health and disease; and, to achieve professional competency, physicians should be knowledgeable about their society and its inhabitants' behavior. This knowledge will help physicians to become competent in communication, professional behavior, self-awareness, ethical reasoning, and understanding cultural and social differences. In this regard, this research is an attempt to explore perspectives of medical faculty members on necessity of integrating Behavioral and Social Sciences (BSS) components into the medical curriculum. Methods: In this qualitative study, data were collected by semi-structured interview and observation of participants who were recruited from educational departments of faculty of medicine of Iran University of Medical Sciences. 12 faculty members were interviewed individually and were ask about their experiences and perspectives on integration of BSS subject matters into medical curriculum. Data were analyzed using content analysis. Results: The six following themes were emerged from data analysis: "physician-patient interaction", "medical culture", "facilitating behavior change", "socio-cultural issues", "mind-body medical experience" and "physician interaction with health care system". Conclusion: The results revealed that "physician-patient interaction" was the most prominent among the emerged themes. The participants emphasized communication, professionalism, social accountability, and socio-cultural-psychological aspects.

Self-regulated learning processes of medical students during an academic learning task.

OBJECTIVES: This study was designed to identify the self-regulated learning (SRL) processes of medical students during a biomedical science learning task and to examine the associations of the SRL processes with previous performance in biomedical science examinations and subsequent performance on a learning task. METHODS: A sample of 76 Year 1 medical students were recruited based on their performance in biomedical science examinations and stratified into previous high and low performers. Participants were asked to complete a biomedical science learning task. Participants' SRL processes were assessed before (self-efficacy, goal setting and strategic planning), during (metacognitive monitoring) and after (causal attributions and adaptive inferences) their completion of the task using an SRL microanalytic interview. Descriptive statistics were used to analyse the means and frequencies of SRL processes. Univariate and multiple logistic regression analyses were conducted to examine the associations of SRL processes with previous examination performance and the learning task performance. RESULTS: Most participants (from 88.2% to 43.4%) reported task-specific processes for SRL measures. Students who exhibited higher self-efficacy (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.09-1.90) and reported task-specific processes for metacognitive monitoring (OR 6.61, 95% CI 1.68-25.93) and causal attributions (OR 6.75, 95% CI 2.05-22.25) measures were more likely to be high previous performers. Multiple analysis revealed that similar SRL measures were associated with previous performance. The use of task-specific processes for causal attributions (OR 23.00, 95% CI 4.57-115.76) and adaptive inferences (OR 27.00, 95% CI 3.39-214.95) measures were associated with being a high learning task performer. In multiple analysis, only the causal attributions measure was associated with high learning task performance. CONCLUSIONS: Self-efficacy, metacognitive monitoring and causal attributions measures were associated positively with previous performance. Causal attributions and adaptive inferences measures were associated positively with learning task performance. These findings may inform remediation interventions in the early years of medical school training.

Sexual Dysfunctional Beliefs Questionnaire (SDBQ): Translation and Psychometric Properties of the Iranian Version.

INTRODUCTION: The sexual dysfunctional beliefs questionnaire (SDBQ) is a validated measure for assessing dysfunctional sexual beliefs. AIMS: The aim of this study was to translate and validate the SDBQ to Iranian context. METHODS: In order to translate the questionnaire from English into Persian, a forward-backward procedure was applied. After linguistic validation, the psychometric properties of the Iranian version were assessed for both men and women. A total of 387 participants (226 women and 161 men) completed the SDBQ. MAIN OUTCOME MEASURES: A principle component analysis with varimax rotation was performed for both the male and female samples. Reliability was evaluated by calculating Cronbach's alpha (internal consistency) and test-retest coefficients (intraclass correlation coefficient). RESULTS: The results from the principle component analysis identified six factors in the female version: sexual conservatism and female sexual passivity, beliefs about masturbation, body image beliefs, sexual desire and pleasure as a sin, age-related beliefs, and denying affection primacy. In the male version six factors were also identified: sex as an abuse of men's power, beliefs related to women's satisfaction, sexual conservatism, female sexual power, "macho" beliefs, and restrictive attitudes toward sex. Findings support the original six-factor solution for the male sample. For the female sample, although a six-factor solution was found, original motherhood-related beliefs were included in the sexual conservatism and female sexual passivity factor, and a new dimension has emerged, related to masturbation beliefs. Additionally, results indicated that the SDBQ had good internal consistency and test-retest reliability in both male and female versions. CONCLUSION: Current findings support the reliability and validity of the SDBQ in an Iranian sample and suggest its applicability to assess sexual beliefs in both clinical samples and the general population in Iran.

Causes of academic failure of medical and medical sciences students in Iran: a systematic review.

BACKGROUND: Academic failure of medical and medical sciences students is one of the major problems of higher education centers in many countries. This study aims to collect and compare relevant researches in this field in Iran. METHODS: The appropriate keywords were searched in the national and international databases, and the findings were categorized into related and non-related articles accordingly. RESULTS: Only 22 articles were included in this systematic review. In terms of content analysis, gender, living in a dorm, employment, marital status, age, special rights in the entrance exams, the time lag between diploma and university, diploma average, learning style, being nonnative students, being a transferred student, psychological problems, occupation of the mother, salary level, diploma type, field of study, self-esteem, exam anxiety and interest on the field of study were considered as the influential factors for academic failure of the students. CONCLUSION: This systematic review shows that there is no definite academic failure criterion. It is also suggested Iranian researchers should pay more attention on the documentation of the higher educational strategies that have been implemented to prevent avoidable academic failure and contain physiological academic failure.

The Relationship Between Nonsuicidal Self-injury and Attachment: Protocol for a Systematic Review and Meta-analysis.

BACKGROUND: The prevalence of nonsuicidal self-injury (NSSI) is a major concern in public health. Two main factors (individual and environmental) cause NSSI. Studies addressing NSSI often consider it as an emotion regulation strategy. Studying NSSI within the framework of attachment theory is reasonable since the capacities to regulate emotion come into existence in the framework of attachment in the first periods of a child's growth. Primary studies addressing this topic are not frequent, and no systematic review has been conducted. OBJECTIVE: This systematic review and meta-analysis protocol aims to investigate the relationship between NSSI and attachment style and finding its relationship based on study design, study type, different types of attachments, and gender. METHODS: All studies on the relationship between NSSI and attachment will be included in this systematic review. We will include observational studies (cross-sectional, cohort, and case control) through searches in electronic databases via PubMed, CINAHL, Embase, Web of Science, ProQuest, Scopus, PsycINFO, and Google Scholar as complementary search. Qualitative studies, case studies, case series, and letters to the editor will be excluded. There will be no language limitation. Moreover, there will be no limitations regarding the study participants' age, gender, nationality, sexual orientation, and psychological problems. Funnel plots were examined if 10 or more studies are included, and the Begg and Egger statistical tests were used to assess the risk of bias. All similar data will be combined through the "metan" command by Stata statistical package (StataCorp). A fixed-effects or random-effects model, considering methodological similarities or differences, will be selected to determine a combination model. RESULTS: We will summarize the selection of the eligible studies using a flowchart. The results will be presented in a table of evidence. The results of the meta-analysis will be depicted using diagrams and tables. CONCLUSIONS: It seems necessary to carry out such systematic and comprehensive meta-analysis to present a summary of the published articles in terms of the relationship between NSSI and attachment. The results from this review will be used to improve our knowledge of the role of the upbringing of children and NSSI behavior and will help design appropriate interventions to address NSSI. TRIAL REGISTRATION: PROSPERO CRD42021226455; https://tinyurl.com/yc77wny8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40808.

Two-factor higher-order model of perfectionism in Iranian general and clinical samples.

BACKGROUND: Studies in Western cultures have shown that perfectionism is conceptualized by two-factor higher-order model including perfectionistic strivings and perfectionistic concerns. However, little is known about the construct of perfectionism in Eastern societies. Thus, we examined the two-factor higher-order model of perfectionism in Iranian general and clinical samples. METHODS: We recruited a general population sample (n = 384) and patients with major depressive disorder, obsessive compulsive disorder, social anxiety disorder, and eating disorders (n = 152) from Tehran, Iran from September 2016 to December 2017. They completed the Clinical Perfectionism Questionnaire, Perfectionism Inventory, and Depression, Anxiety, Stress Scale-21. RESULTS: The two-factor higher-order model of perfectionism showed adequate fit with data for females from the general population and clinical sample. Data for males were only available from the general population, and the model showed adequate fit with the data first after removing the Rumination scale of the perfectionistic concerns. The perfectionistic strivings dimension showed no or negative association with depression, anxiety, and stress symptoms, but perfectionistic concerns dimension showed positive correlation with these indices in all samples for both males and females. CONCLUSIONS: The results support the two-factor higher-order model of perfectionism in samples of Iranian females from the general population and clinical sample. However, the results were different for males from the general population. In other words, the modified two-factor higher-order model showed acceptable fit with the data for males from the general population only after removing the Rumination scale from perfectionistic concerns. These differences among males and females were discussed.

The educational effects of mobile learning on students of medical sciences: A systematic review in experimental studies.

INTRODUCTION: The demand for mobile learning in the medical science educational program is increasing. The present review study gathers evidence highlighted by the experimental studies on the educational effects of mobile learning for medical science students. METHODS: The study was carried out as a systematic literature search published from 2007 to July 2017 in the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Knowledge (Thomson Reuters) , Educational Resources and Information Center (ERIC), EMBASE (Elsevier), Cochrane library, PsycINFO and Google Scholar. To examine quality of the articles, a tool validated by the BEME Review was employed. RESULTS: Totally, 21 papers entered the study. Three main themes emerged from the content of papers: (1) improvement in student clinical competency and confidence, (2) acquisition and enhancing of students' theoretical knowledge, and (3) students' positive attitudes to and perception of mobile learning. Level 2B of Kirkpatrick hierarchy had been examined by all the papers and seven of them had reported two or more outcome levels, but level 4 was not reported in the papers. CONCLUSION: Our review showed that the students of medical sciences had positive response and attitudes to mobile learning. Moreover, implementation of mobile learning in medical sciences program might lead to valuable educational benefits and improve clinical competence and confidence along with theoretical knowledge, attitudes, and perception of mobile learning. The results indicated that mobile learning strategy in medical education can positively affect learning in all three domains of Bloom's Taxonomy.

Transdiagnostic Treatment of Co-occurrence of Anxiety and Depressive Disorders based on Repetitive Negative Thinking: A Case Series.

OBJECTIVE: The transdiagnostic cognitive behavioral treatments for treating the coexistence of anxiety and mood disorders received useful empirical supports in the recent years. However, these treatments still have moderate efficacy. Following the improvements and developments in transdiagnostic protocols and considering the importance of repetitive negative thinking as a core transdiagnostic factor in emotional disorders, this study examined a new form of transdiagnostic treatment based on Repetitive Negative Thinking (TTRNT) of co-occurrence of anxiety and depressive disorders. METHODS: Treatment efficacy was assessed using single case series with multiple baselines. Three patients meeting the criteria for co-occurrence of anxiety and depressive disorders were selected using the Anxiety Disorders Interview Schedule for DSM-IV. The patients were treated individually for 12 weekly sessions. Participants completed the standardized outcome measures during the baseline, treatment and one-month follow-up. RESULTS: At post-treatment, all participants showed significant clinical changes on a range of standardized outcome measures, and these gains were largely maintained through the one-month follow-up both in the principle and co-principal diagnosis. CONCLUSIONS: Although the results of this preliminary investigation indicated that TTRNT could be a time effective and efficient treatment for individuals with co-occurrence of anxiety and depressive disorders, further controlled clinical trials are necessary to examine this new treatment approach.

Comparing attentional control and intrusive thoughts in obsessive-compulsive disorder, generalized anxiety disorder and non clinical population.

OBJECTIVE: Attention is an important factor in information processing; obsessive- compulsive disorder (OCD) and generalized anxiety disorder (GAD) are two main emotional disorders with a chronic course. This research examined the relationship among attentional control and intrusive thoughts (worry, rumination and obsession) in these disorders. It was hypothesized that attentional control is a common factor in OCD and GAD. In addition, we compared worry, rumination and obsession among OCD, GAD and non- clinical participants. METHOD: The research sample included three groups: OCD (n = 25), GAD (n = 30) and non- clinical samples (n = 56). Data were collected using the Attentional Control Scale (ACS), Rumination Response Scale (RRS), Pennsylvania State Worry Questionnaire (PSWQ), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Obsessive-Compulsive Inventory-Revised (OCI-R) and General Health Questionnaire (GHQ-28). Data were analyzed using MANOVA and MANCOVA by SPSS-17. RESULT: Multivariate Analysis of Variance revealed that the OCD and GAD groups reported greater deficits in attentional control, higher obsessive-compulsive symptoms, rumination, worry, anxiety and depression compared to the control group. CONCLUSION: This research indicated a great attentional deficit in obsessive- compulsive disorder and generalized anxiety disorder. However, no significant difference was found between these two disorders.

Facial emotion recognition in adolescents with bipolar disorder.

OBJECT: Bipolar disorder (BD) is associated with abnormalities in emotional competence. One of the main aspects of this competency is emotion recognition which is presented in the face. This study aimed to evaluate facial emotion recognition in adolescents with bipolar disorder when they are free of acute symptoms. METHOD: Thirty patients diagnosed with BD aged 12 to 18 were selected from a large sample of consecutive admitted adolescents in Roozbeh hospital. They were compared with 30 matched normal developing adolescents who were recruited from mainstream schools at Tehran. All participants were evaluated using a facial emotion recognition task. The participants needed to recognize happy, sad, angry and neutral facial expressions The ANOVA was used to analyze the differences between the two groups in terms of emotion recognition variables. RESULTS: The patients with BD showed a significant deficit in recognizing emotions in general (p=.01) which was prominent in the angry faces. Their response time to recognize the facial expressions was longer compared to the normal individuals. This difference was significant in recognizing the happy and neutral faces (p<0.05). CONCLUSION: This study suggests an inaccurate recognition of facial expressions in adolescents with BD, particularly for anger, as well as slowness in detecting emotions especially happiness.