What makes mentors thrive? An exploratory study of their satisfaction in undergraduate medical education.

BACKGROUND: Mentoring medical students with varied backgrounds and individual needs can be challenging. Mentors' satisfaction is likely to be important for the quality and sustainability of mentorships, especially in programs where the mentor has responsibility for facilitating a group of mentees. However, little is known about what influences mentors' satisfaction. The aim of this study was to measure mentors' self-reported satisfaction with the mentoring experience and to explore associations between satisfaction and its putative factors. METHODS: An online survey was sent out to all physician mentors in each of the three mentorship programs (UiT The Arctic University of Norway, the University of Bergen, and McGill University, graduation years 2013-2020, n = 461). Data were analyzed by descriptive statistics, dimension reduction, and linear regression. RESULTS: On a scale from 1 to 5, mean mentor satisfaction score at two Norwegian and one Canadian medical school was 4.55 (95% CI 4.47, 4.64). In a multilevel multivariate regression analysis, two predictors were significantly associated with mentors' satisfaction: (1) the perception that students found the group meetings valuable (ß = 0.186, 95% CI 0.021, 0.351, p = 0.027) and (2) mentors' perceived rewards (ß = 0.330, 95% CI 0.224, 0.437, p < 0.001). Perceived rewards included experiencing gratifying relationships with students, and mentors' perception of self-development. CONCLUSIONS: In this study, mentors appeared to be highly satisfied with their mentoring functions. Our findings suggest that mentors' overall satisfaction is closely linked to their experiences of fulfilling mentor-student relationships and personal and professional development. Interestingly, and perhaps contrary to commonly held assumptions, we found no association between mentor satisfaction and financial compensation. Furthermore, satisfaction was not associated with the provision of pre-assigned topics for discussions for mentor group meetings. We propose that the mentors' experienced psycho-social rewards, and their competence in establishing well-functioning group dynamics, should be areas of focus for faculty development.

Self-reported medication information needs among medication users in a general population aged 40 years and above - the Tromsø study.

PURPOSE: To determine the prevalence and associated factors of self-reported medication information needs among medication users in a general population aged 40 years and above - The Tromsø Study. METHODS: Cross-sectional study of medication users (n = 10,231) among participants in the Tromsø Study, a descriptive analysis of questionnaire data and multivariable logistic regression (n = 9,194). RESULTS: Sixteen percent of medication users expressed a need for more information about own medications. Overall, medication users agreed to a higher degree to have received information from the GP compared to the pharmacy. Concerned medication users and those disagreeing to have received information about side effects had the highest odds for needing more information (OR 5.07, 95% CI 4.43-5.81) and (OR 2.21, 95% CI 1.83-2.68), respectively. Medication users who used heart medications (e.g., nitroglycerin, antiarrhythmics, anticoagulants) (OR 1.71, 95% CI 1.46-2.01), medication for hypothyroidism (OR 1.36, 95% CI 1.13-1.64) or had moderately health anxiety had expressed need for medication information. Whereas medication users with lower education, those that never used internet to search for health advice, and medication users who disagreed to have received information about reason-for-use were associated with lower odds (OR 0.75, 95% CI 0.62-0.91), (OR 0.85, 95% CI 0.74-0.98) and (OR 0.68, 95% CI 0.53-0.88), respectively. CONCLUSION: This study demonstrated that there is need for more information about own medications in a general population aged 40 years and above and shed light on several characteristics of medication users with expressed information need which is important when tailoring the right information to the right person.

The association between health anxiety, physical disease and cardiovascular risk factors in the general population - a cross-sectional analysis from the Tromsø study: Tromsø 7.

BACKGROUND: Health anxiety (HA) is defined as a worry of disease. An association between HA and mental illness has been reported, but few have looked at the association between HA and physical disease. OBJECTIVE: To examine the association between HA and number of diseases, different disease categories and cardiovascular risk factors in a large sample of the general population. METHODS: This study used cross-sectional data from 18,432 participants aged 40 years or older in the seventh survey of the Tromsø study. HA was measured using a revised version of the Whiteley Index-6 (WI-6-R). Participants reported previous and current status regarding a variety of different diseases. We performed exponential regression analyses looking at the independent variables 1) number of diseases, 2) disease category (cancer, cardiovascular disease, diabetes or kidney disease, respiratory disease, rheumatism, and migraine), and 3) cardiovascular risk factors (high blood pressure or use of cholesterol- or blood pressure lowering medication). RESULTS: Compared to the healthy reference group, number of diseases, different disease categories, and cardiovascular risk factors were consistently associated with higher HA scores. Most previous diseases were also significantly associated with increased HA score. People with current cancer, cardiovascular disease, and diabetes or kidney disease had the highest HA scores, being 109, 50, and 60% higher than the reference group, respectively. CONCLUSION: In our general adult population, we found consistent associations between HA, as a continuous measure, and physical disease, all disease categories measured and cardiovascular risk factors.

Health anxiety is an important driver of healthcare use.

BACKGROUND: Healthcare use is increasing, and health anxiety (HA) is recognized as an important associated factor. Previous research on the association between HA and healthcare use has mostly explored HA as a dichotomous construct, which contrasts the understanding of HA as a continuous construct, and compared healthcare use to non-use. There is a need for studies that examine the association between healthcare use and the continuum of HA in a general population. AIM: To explore the association between HA and primary, somatic specialist and mental specialist healthcare use and any differences in the association by level of healthcare use. METHODS: This study used cross-sectional data from the seventh Tromsø study. Eighteen thousand nine hundred sixty-seven participants aged 40 years or older self-reported their primary, somatic specialist and mental specialist healthcare use over the past 12 months. Each health service was categorized into 5 groups according to the level of use. The Whiteley Index-6 (WI-6) was used to measure HA on a 5-point Likert scale, with a total score range of 0-24. Analyses were conducted using unconstrained continuation-ratio logistic regression, in which each level of healthcare use was compared with all lower levels. Morbidity, demographics and social variables were included as confounders. RESULTS: HA was positively associated with increased utilization of primary, somatic specialist and mental specialist healthcare. Adjusting for confounders, including physical and mental morbidity, did not alter the significant association. For primary and somatic specialist healthcare, each one-point increase in WI-6 score yielded a progressively increased odds ratio (OR) of a higher level of use compared to all lower levels. The ORs ranged from 1.06 to 1.15 and 1.05 to 1.14 for primary and somatic specialist healthcare, respectively. For mental specialist healthcare use, the OR was more constant across levels of use, ranging between 1.06 and 1.08. CONCLUSIONS: In an adult general population, HA, as a continuous construct, was significantly and positively associated with primary, somatic specialist and mental healthcare use. A small increase in HA was associated with progressively increased healthcare use across the three health services, indicating that the impact of HA is more prominent with higher healthcare use.

Distribution of health anxiety in a general adult population and associations with demographic and social network characteristics.

BACKGROUND: Health anxiety (HA) is associated with increased risk of disability, increased health care utilization and reduced quality of life. However, there is no consensus on which factors are important for the level of HA. The aim of this study was to explore the distribution of HA in a general adult population and to investigate whether demographic and social factors were associated with HA. METHODS: This study used cross-sectional data from the seventh Tromsø study. A total of 18 064 participants aged 40 years or older were included in the analysis. The six-item Whiteley Index (WI-6) with a 5-point Likert scale was used to measure HA. Sociodemographic factors included age, sex, education, household income, quality of friendship and participation in an organized activity. RESULTS: HA showed an exponential distribution among the participants with a median score of 2 points out of 24 points. In total, 75% had a total score of 5 points or less, whereas 1% had a score >14 points. Education, household income, quality of friendship and participation in organized activity were significantly associated with HA. The variable quality of friendship demonstrated the strongest association with HA. CONCLUSION: Our study showed an exponential distribution of HA in a general adult population. There was no evident cut-off point to distinguish participants with severe HA based on their WI-6 score, indicating the importance of analysing HA as a complex, continuous construct. HA demonstrated strong associations with quality of friendship and participation in an organized activity.

Group mentorship for undergraduate medical students-a systematic review.

INTRODUCTION: Mentoring has become a prevalent educational strategy in medical education, with various aims. Published reviews of mentoring report very little on group-based mentorship programs. The aim of this systematic review was to identify group-based mentorship programs for undergraduate medical students and describe their aims, structures, contents and program evaluations. Based on the findings of this review, the authors provide recommendations for the organization and assessment of such programs. METHODS: A systematic review was conducted, according to PRISMA guidelines, and using the databases Ovid MEDLINE, EMBASE, PsycINFO and ERIC up to July 2019. Eight hundred abstracts were retrieved and 20 studies included. Quality assessment of the quantitative studies was done using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS: The 20 included studies describe 17 different group mentorship programs for undergraduate medical students in seven countries. The programs were differently structured and used a variety of methods to achieve aims related to professional development and evaluation approaches. Most of the studies used a single-group cross-sectional design conducted at a single institution. Despite the modest quality, the evaluation data are remarkably supportive of mentoring medical students in groups. DISCUSSION: Group mentoring holds great potential for undergraduate medical education. However, the scientific literature on this genre is sparse. The findings indicate that group mentorship programs benefit from being longitudinal and mandatory. Ideally, they should provide opportunities throughout undergraduate medical education for regular meetings where discussions and personal reflection occur in a supportive environment.

The prevalence of severe grief reactions after bereavement and their associations with mental health, physical health, and health service utilization: a population-based study.

Background: Previous research has shown that bereaved individuals are at risk of developing physical and mental health problems. However, knowledge is scarce about the associations between severe grief reactions after bereavement and physical and mental health problems and the use of health services. Objectives: The present study sought to investigate the prevalence of severe grief reactions and to study the associations of severe grief reactions with mental and physical health and health care utilization. Method: The sample comprised 20,453 adults aged 40 and above (mean age = 57.2 years, SD = 11.3 years, 52.4% female) who participated in the seventh wave of the Tromsø study. Severe grief was assessed with one question asking whether the respondent has experienced the death of a loved one and currently has difficulty accepting the loss, yearns for the deceased, and experiences intense emotional pain related to the loss. Furthermore, participants answered questions about their current physical health, mental health (Hopkins Symptom Checklist - 10), and the use of health services in the past year. Results: Overall, 5.2% of the participants reported severe grief after a loss in childhood, 25.9% after bereavement in adulthood and 4.1% after bereavement in the previous year. Female gender, higher age, living without a partner, non-Norwegian ethnicity, and lower socio-economic status were associated with severe grief. Severe grief reactions were negatively related to self-reported health, predicted positively current levels of depression and anxiety, and were positively associated with the use of health services. Effect sizes were small. Gender differences in the use of health services were observed. Conclusion: Severe grief reactions are common in individuals aged 40 and older and associated with self-reported physical and mental health problems as well as increased use of health services. Health service providers should be attentive to possible severe grief in connection with health complaints.

Antecedentes: Investigaciones previas han mostrado que los individuos que han perdido a seres queridos se encuentran en mayor riesgo de desarrollar problemas de salud física y mental. Sin embargo, es escaso el conocimiento sobre las asociaciones entre las reacciones severas de duelo luego de la pérdida y los problemas de salud física y mental y el uso de los servicios de salud.Objetivo: El presente estudio buscó investigar la prevalencia de las reacciones severas de duelo y estudiar las asociaciones de las reacciones severas de duelo con la salud física y mental y la utilización de atención de salud.Método: La muestra se compuso de 20.453 adultos de 40 años y más (edad promedio = 57.2 años, DS = 11.3 años, 52.4% mujeres) que participaron en la séptima etapa del estudio Tromsø. El duelo severo se midió con una pregunta indagando si el encuestado ha experimentado la muerte de un ser querido y si actualmente tiene dificultades aceptando la pérdida, ansia del fallecido/a, y experimenta dolor emocional intenso relacionado a la pérdida. Además, los participantes respondieron preguntas sobre su actual salud física, salud mental (Lista de Chequeo de Síntomas de Hopkins­10), y el uso de los servicios de salud en el último año.Resultados: En general, 5.2% de los participantes reportaron duelo severo después de una pérdida en la infancia, 25.9% luego de la pérdida de un ser querido en la adultez y 4.1% luego de una pérdida en el último año. Se asociaron con el duelo severo el género femenino, una mayor edad, vivir sin una pareja, no ser de etnia noruega, y estatus socioeconómico más bajo. Las reacciones severas de duelo se relacionaron negativamente con el auto-reporte de salud, predijo positivamente los niveles actuales de depresión y ansiedad, y fueron asociados positivamente con el uso de los servicios de salud. Los tamaños de los efectos fueron pequeños. Se observaron diferencias de género en el uso de los servicios de salud.Conclusión: Las reacciones severas de duelo son comunes en los individuos de 40 y más años y se asociaron con el auto-reporte de problemas de salud física y mental como también con un incremento del uso de los servicios de salud. Los proveedores de los servicios de salud deberían estar atentos a la posible conexión entre el duelo severo y las quejas de salud.

Examining the variation in GPs' referral practice: a cross-sectional study of GPs' reasons for referral.

BACKGROUND: There is a large variation in referral rates to secondary care among GPs, which is partly unexplained. AIM: To explore associations between reasons for referral to secondary care and patient, GP, and healthcare characteristics. DESIGN AND SETTING: A cross-sectional study in Northern Norway. METHOD: Data were derived from 44 (42%) of 104 randomly selected GPs between 2008 and 2010. GPs scored the relevance of nine predefined reasons for 595 referrals from 4350 consecutive consultations on a four-level categorical scale. Associations were examined by multivariable ordered and multivariable multilevel logistic regression analyses. RESULTS: Medical necessity was assessed as a relevant reason in 93% of the referrals, 43.7% by patient preference, 27.5% to avoid overlooking anything, and 14.6% to reassure the patient. The higher the referral rates, the more frequently the GPs referred to avoid overlooking anything. Female GPs referred to reassure the patient and due to perceived deficient medical knowledge significantly more often than male GPs. However, perceived easy accessibility of specialists was significantly less frequently given as a reason for referral by female GPs compared with male GPs. When the GPs scored the referrals to be of lesser medical necessity, male GPs referred significantly more frequently than female GPs to reassure the patient due to patient preference and perceived deficient medical knowledge. CONCLUSION: There are striking differences in reasons for referral between Norwegian male and female GPs and between GPs with high and low referral rates, which reflects difficulties in handling professional uncertainty. Referring to reassure the patients, especially when referrals are less medically necessary, may reflect consideration and acquiescence towards the patients.

High referral rates to secondary care by general practitioners in Norway are associated with GPs' gender and specialist qualifications in family medicine, a study of 4350 consultations.

BACKGROUND: Referral rates of general practitioners (GPs) are an important determinant of secondary care utilization. The variation in these rates across GPs is considerable, and cannot be explained by patient morbidity alone. The main objective of this study was to assess the GPs' referral rate to secondary care in Norway, any associations between the referral decision and patient, GP, health care characteristics and who initiated the referring issue in the consultation. METHODS: The probabilities of referral to secondary care and/or radiological examination were examined in 100 consecutive consultations of 44 randomly chosen Norwegian GPs. The GPs recorded whether the issue of referral was introduced, who introduced it and if the patient was referred. Multilevel and naive multivariable logistic regression analyses were performed to explore associations between the probability of referral and patient, GP and health care characteristics. RESULTS: Of the 4350 consultations included, 13.7% (GP range 4.0%-28.0%) of patients were referred to secondary somatic and psychiatric care. Female GPs referred significantly more frequently than male GPs (16.0% versus 12.6%, adjusted odds ratio, AOR, 1.25), specialists in family medicine less frequently than their counterparts (12.5% versus 14.9%, AOR 0.76) and salaried GPs more frequently than private practitioners (16.2% versus 12.1%, AOR 1.36).In 4.2% (GP range 0%-12.9%) of the consultations, patients were referred to radiological examination. Specialists in family medicine, salaried GPs and GPs with a Norwegian medical degree referred significantly more frequently to radiological examination than their counterparts (AOR 1.93, 2.00 and 1.73, respectively).The issue of referral was introduced in 23% of the consultations, and in 70.6% of these cases by the GP. The high referrers introduced the referral issue significantly more frequently and also referred a significantly larger proportion when the issue was introduced. CONCLUSIONS: The main finding of the present study was a high overall referral rate, and a striking range among the GPs. Male GPs and specialists in family medicine referred significantly less frequently to secondary care, but the latter referred more frequently to radiological examination. Our findings indicate that intervention on high referrers is a potential area for quality improvement, and there is a need to explore the referral decision process itself.

Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial.

OBJECTIVE: To assess whether colon cancer follow-up can be organised by general practitioners (GPs) without a decline in the patient's quality of life (QoL) and increase in cost or time to cancer diagnoses, compared to hospital follow-up. DESIGN: Randomised controlled trial. SETTING: Northern Norway Health Authority Trust, 4 trusts, 11 hospitals and 88 local communities. PARTICIPANTS: Patients surgically treated for colon cancer, hospital surgeons and community GPs. INTERVENTION: 24-month follow-up according to national guidelines at the community GP office. To ensure a high follow-up guideline adherence, a decision support tool for patients and GPs were used. MAIN OUTCOME MEASURES: Primary outcomes were QoL, measured by the global health scales of the European Organisation for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ C-30) and EuroQol-5D (EQ-5D). Secondary outcomes were cost-effectiveness and time to cancer diagnoses. RESULTS: 110 patients were randomised to intervention (n=55) or control (n=55), and followed by 78 GPs (942 follow-up months) and 70 surgeons (942 follow-up months), respectively. Compared to baseline, there was a significant improvement in postoperative QoL (p=0.003), but no differences between groups were revealed (mean difference at 1, 3, 6, 9, 12, 15, 18, 21 and 24-month follow-up appointments): Global Health; Δ-2.23, p=0.20; EQ-5D index; Δ-0.10, p=0.48, EQ-5D VAS; Δ-1.1, p=0.44. There were no differences in time to recurrent cancer diagnosis (GP 35 days vs surgeon 45 days, p=0.46); 14 recurrences were detected (GP 6 vs surgeon 8) and 7 metastases surgeries performed (GP 3 vs surgeon 4). The follow-up programme initiated 1186 healthcare contacts (GP 678 vs surgeon 508), 1105 diagnostic tests (GP 592 vs surgeon 513) and 778 hospital travels (GP 250 vs surgeon 528). GP organised follow-up was associated with societal cost savings (£8233 vs £9889, p<0.001). CONCLUSIONS: GP-organised follow-up was associated with no decline in QoL, no increase in time to recurrent cancer diagnosis and cost savings. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00572143.

Is a high level of general practitioner consultations associated with low outpatients specialist clinic use? A cross-sectional study.

OBJECTIVE: To examine if increased general practice activity is associated with lower outpatient specialist clinic use. DESIGN: Cross-sectional population based study. SETTING: All 430 Norwegian municipalities in 2009. PARTICIPANTS: All Norwegians aged ≥65 years (n=721 915; 56% women-15% of the total population). MAIN OUTCOME MEASURE: Specialised care outpatient clinic consultations per 1000 inhabitants (OPC rate). Main explanatory: general practitioner (GP) consultations per 1000 inhabitants (GP rate). RESULTS: In total, there were 3 339 031 GP consultations (57% women) and 1 757 864 OPC consultations (53% women). The national mean GP rate was 4625.2 GP consultations per 1000 inhabitants (SD 1234.3) and the national mean OPC rate was 2434.3 per 1000 inhabitants (SD 695.3). Crude analysis showed a statistically significant positive association between GP rates and OPC rates. In regression analyses, we identified three effect modifiers; age, mortality and the municipal composite variable of 'hospital status' (present/not present) and 'population size' (small, medium and large). We stratified manually by these effect modifiers into five strata. Crude stratified analyses showed a statistically significant positive association for three out of five strata. For the same three strata, those in the highest GP consultation rate quintile had higher mean OPC rates compared with those in the lowest quintile after adjustment for confounders (p<0.001). People aged ≥85 in small municipalities had approximately 30% lower specialist care use compared with their peers in larger municipalities, although the association between GP-rates and OPC-rates was still positive. CONCLUSIONS: In a universal health insurance system with high GP-accessibility, a health policy focusing solely on a higher activity in terms of GP consultations will not likely decrease OPC use among elderly.

Socio-economic inequalities in health care utilisation in Norway: a population based cross-sectional survey.

BACKGROUND: Norway provides universal health care coverage to all residents, but socio-economic inequalities in health are among the largest in Europe. Evidence on inequalities in health care utilisation is sparse, and the aim of this population based study was to investigate socio-economic inequalities in the utilisation of health care services in Tromsø, Norway. METHODS: We used questionnaire data from the cross-sectional Tromsø Study, conducted in 2007-8. All together 12,982 persons aged 30-87 years participated with the response rate of 65.7%. This is slightly more than one third of the total population (33.8%) in the mentioned age group in Tromsø municipality. By logistic regression analyses we studied associations between household income, education and self-rated occupational status and the utilisation of general practitioner, somatic and psychiatric specialist outpatient services. The outcome variables were probability and frequency of use during the previous 12 months. Analyses were stratified by gender and adjusted for age, marital status, and self-rated health. RESULTS: Self-rated health was the dominant predictor of health care utilisation. Women's probability of visiting a general practitioner did not vary by socio-economic status, but high income was associated with less frequent use (odds ratio [OR] for trend 0.89, 95% confidence interval [CI] 0.81-0.98). In men, high income predicted lower probability and frequency of general practitioner utilisation (OR for trend 0.85, CI 0.76-0.94, and 0.86, 0.78-0.95, respectively). Women's probability of visiting a somatic specialist increased with higher income (OR for trend 1.11, CI 1.01-1.21) and higher education (OR for trend 1.27, CI 1.16-1.39). We found the same trends for men, though significant only for education (OR for trend 1.14, CI 1.05-1.25). The likelihood of visiting psychiatric specialist services increased with higher education and decreased with higher income in women (OR for trend 1.57, CI 1.24-1.98, and 0.69, 0.56-0.86, respectively), but did not vary significantly by socio-economic variables in men. Higher income predicted more frequent use of psychiatric specialist services in men (OR for trend 2.02, CI 1.12-3.63). CONCLUSIONS: This study revealed important inequalities in the utilisation of health care services in Norway, inequalities which may contribute to sustaining inequalities in health outcomes.

Should the surgeon or the general practitioner (GP) follow up patients after surgery for colon cancer? A randomized controlled trial protocol focusing on quality of life, cost-effectiveness and serious clinical events.

BACKGROUND: All patients who undergo surgery for colon cancer are followed up according to the guidelines of the Norwegian Gastrointestinal Cancer Group (NGICG). These guidelines state that the aims of follow-up after surgery are to perform quality assessment, provide support and improve survival. In Norway, most of these patients are followed up in a hospital setting. We describe a multi-centre randomized controlled trial to test whether these patients can be followed up by their general practitioner (GP) without altering quality of life, cost effectiveness and/or the incidence of serious clinical events. METHODS AND DESIGN: Patients undergoing surgery for colon cancer with histological grade Dukes's Stage A, B or C and below 75 years of age are eligible for inclusion. They will be randomized after surgery to follow-up at the surgical outpatient clinic (control group) or follow-up by the district GP (intervention group). Both study arms comply with the national NGICG guidelines. The primary endpoints will be quality of life (QoL) (measured by the EORTC QLQ C-30 and the EQ-5D instruments), serious clinical events (SCEs), and costs. The follow-up period will be two years after surgery, and quality of life will be measured every three months. SCEs and costs will be estimated prospectively. The sample size was 170 patients. DISCUSSION: There is an ongoing debate on the best method of follow-up for patients with CRC. Due to a wide range of follow-up programmes and paucity of randomized trials, it is impossible to draw conclusions about the best combination and frequency of clinic (or family practice) visits, blood tests, endoscopic procedures and radiological examinations that maximize the clinical outcome, quality of life and costs. Most studies on follow-up of CRC patients have been performed in a hospital outpatient setting. We hypothesize that postoperative follow-up of colon cancer patients (according to national guidelines) by GPs will not have any impact on patients' quality of life. Furthermore, we hypothesize that there will be no increase in SCEs and that the incremental cost-effectiveness ratio will improve. TRIAL REGISTRATION: This trial has been registered at ClinicalTrials.gov. The trial registration number is: NCT00572143.