Development and validation of the physician self-efficacy to manage emotional challenges Scale (PSMEC).

BACKGROUND: Medical students experience emotional challenges during their undergraduate education, often related to work-based learning. Consequently, they may experience feelings of uncertainty and self-doubt, which can negatively affect their well-being. Therefore, it is crucial to support students' development of their ability to manage distressful situations. Self-efficacy beliefs may be a central aspect of supporting them in this development, and have been shown to relate to resilient factors such as students' motivation, learning, and well-being. METHODS: We constructed a scale to measure medical students' physician self-efficacy to manage emotional challenges during work-based learning, the PSMEC scale. The aim of the present study was to evaluate some of the psychometric properties of the PSMEC scale. The scale consists of 17 items covering five subscales: (1) medical knowledge and competence, (2) communication with difficult patients and delivering bad news, (3) being questioned and challenged, (4) educative competence in patient encounters, and (5) ability to establish and maintain relationships with healthcare professionals. Data were collected from 655 medical students from all seven medical schools in Sweden. To investigate the scale's dimensionality and measurement invariance with regard to gender and time in education, single and multiple group confirmatory factor models were estimated using techniques suitable for ordered categorical data. Measures of Cronbach's alpha were calculated to evaluate internal consistency. RESULTS: The scale showed good internal consistency on both the global dimension and the five subdimensions of self-efficacy. In addition, the scale was shown to be measurement invariant across genders and times in education, indicating that the scale means of male and female medical students and the scale means of students at the middle and end of their education can be compared. CONCLUSIONS: The physician self-efficacy to manage emotional challenges scale demonstrated satisfactory psychometric properties, with regards to dimensionality, internal consistency, and measurement invariance relating to gender and time in education, and this study supports the usefulness of this scale when measuring self-efficacy in relation to emotional challenges.

Proposing and testing the pathways from bullying victimization to bringing a weapon to school.

OBJECTIVE: The current study examined whether bullying victimization was associated with bringing a weapon to school, fully or partly mediated by feeling unsafe in school, negative future education orientation, and skipping school. METHOD: Data from 6199 students (12-18 years old), who had filled out the 2017 School Crime Supplement to the National Crime Victimization Survey, were analyzed. RESULTS: The results showed a positive association between bullying victimization and bringing a weapon to school. The link was both direct and indirect through the mediating roles of feeling unsafe in school, having a negative future education orientation, and skipping school. CONCLUSION: Thus, victims of bullying tended to feel unsafe in school, have a negative future education orientation, and skip school-all of which were positively associated with bringing a weapon to school.

Shaping Citizenship in the Classroom: Peer Influences on Moral Disengagement, Social Goals, and a Sense of Peer Community.

Despite the important role of peers in the social process of classroom citizenship, the peer influence related to moral disengagement, social goals, and a sense of peer community remain unclear. To this end, it was examined to what extent youth become similar to their friends in moral disengagement, social goals, and a sense of peer community. Participants were 283 South Korean third to sixth graders (Mage = 9.60 years, SD = 0.97; 51.6% girls) who completed an online survey for moral disengagement, social goals, the sense of peer community and friendship network across the beginning (Time 1) and end (Time 2) of the school semester (September to December). Longitudinal social network analyses indicated that youth became more similar to their friends concerning moral disengagement and a sense of peer community, but did not select friends based on these aspects. The strength of these influence effects varied in terms of different levels of these aspects. Specifically, youth were more likely to become similar to their friends at lower levels of moral disengagement. Youth tended to be similar to the friends' level of sense of peer community. This tendency was relatively strong at the lowest and the highest levels of a sense of peer community. Future research should address the role of friendship in shaping classroom citizenship and the importance of classroom daily teaching practice in youth citizenship development.

Pathways from Polyvictimization to Offline and Online Sexual Harassment Victimization Among South Korean Adolescents.

This study aimed to investigate the association between polyvictimization and offline and online sexual harassment and whether the association might be mediated by internalizing problems, low school satisfaction, and dropping out of school. The analytic sample was derived from the Children and Youth Rights Survey in South Korea. It consisted of 6353 adolescents' responses to the sexual harassment question and a set of other questions in the middle and high school questionnaires. The findings showed a direct association between polyvictimization and offline and online sexual harassment. Adolescents who were polyvictimized were more likely to be victims of both forms of sexual harassment. Furthermore, polyvictimization was positively related to dropping out of school, which was positively associated with offline sexual harassment. The findings from the study have significant implications for future research and practice.

The impact of emotionally challenging situations on medical students' professional identity formation.

In their interactions with patients and health care professionals during work-based learning, medical students are known to experience emotionally challenging situations that can evoke negative feelings. Students have to manage these emotions. Students learn and develop their professional identity formation through interactions with patients and members of the healthcare teams. Earlier studies have highlighted the issues involved with processing emotionally challenging situations, although studies concerning learning and professional identity formation in response to these experiences are rare. In this study, we explored medical students' experiences of emotionally challenging situations in work-based learning, and the impact these experiences had on forming medical students' professional identities. We conducted an analysis of narrative data (n = 85), using a constructivist grounded theory approach. The narratives were made up of medical students' reflective essays at the end of their education (tenth term). The analysis showed that students' main concern when facing emotionally challenging situations during their work-based education was the struggle to achieve and maintain a professional approach. They reported different strategies for managing their feelings and how these strategies led to diverse consequences. In the process, students also described arriving at insights into their own personal needs and shortcomings. We consider this development of self-awareness and resulting self-knowledge to be an important part of the continuously ongoing socialization process of forming a professional identity. Thus, experiencing emotionally challenging situations can be considered a unique and invaluable opportunity, as well as a catalyst for students' development. We believe that highlighting the impact of emotions in medical education can constitute an important contribution to knowledge about the process of professional identity formation. This knowledge can enable faculty to provide students with more effective and sufficient support, facilitating their journey in becoming physicians.

Longitudinal Links of Individual and Collective Morality with Adolescents' Peer Aggression.

Adolescents' aggressive behavior has been often linked to biases in morality. However, limited knowledge is available regarding the relative strength of different moral correlates, both at the individual and class-level, in predicting different types of aggressive behavior over time. To address this gap, the present study tested the prospective associations of moral identity and moral disengagement with reactive and proactive aggression in a short-term longitudinal study. The sample consisted of 1158 Italian adolescents (48.7% females; Mage = 13.6 years, SD = 1.1). Participants completed self-report measures of moral identity, moral disengagement, perceived collective moral disengagement in the fall, and reactive and proactive aggression in the fall and in the spring. Multivariate multilevel analysis indicated that, at the individual level, after controlling for the stability of aggressive behavior, T2 (Time 2) reactive aggression was higher for students who reported lower moral identity and higher moral disengagement at T1 (Time 1). For proactive aggression, a significant interaction effect indicated that the negative association between T1 moral identity and T2 aggression was apparent only at high levels of T1 moral disengagement. Moreover, proactive aggression was significantly predicted by higher perceived collective moral disengagement. At the class-level, T1 collective moral disengagement helped explain between-class variability of T2 reactive and proactive aggressive behavior. How these results expand previous research on morality and aggressive behavior and their potential implications for prevention and intervention programs is discussed.

A work motivational grounded theory study of workers in caring roles.

The aim of this study was to examine and construct a theoretical model of key elements that care workers perceive to have an impact on their autonomy, cohesion, and work motivation. Grounded theory was used for data collection and analysis. There were 20 participants from social welfare service, geriatric care, and women's aid settings (women = 18, men = 2, mean age = 37.6). The analysis resulted in the following categories: (a) Being-a-Cohesive-Team; (b) Agency-Making; (c) Living-Up-to-Expectations; and (d) Developing-Support-and-Feedback. The results identified potential interactions between these factors and suggested how they influenced each other, showing how cohesion, autonomy, and motivation are interdependent and amplified.

Cyberbullying and cybervictimization among preadolescents: Does time perspective matter?

Time perspective has been recognized as an important psychological dimension with a pervasive and powerful influence on human behavior. To the authors' knowledge, no studies have focused on the relationship between time perspective and cyberbullying behavior. The first aim of this research is to fill this gap by investigating the relationship between different time perspectives and both cyberbullying and cybervictimization among 6th to 8th grade students. The second objective was to investigate the relationship between time perspective, cyberbullying behaviors, peer problems, and the quality of relationship with teachers. A sample consisting of 403 students aged between 11 and 14 years from Italian middle schools (56% females, mean age = 12.2 years) were recruited. Participants filled in a self-report questionnaire measuring cyberbullying and cybervictimization as well as the Time Perspective questionnaire. The analyses showed the presence of significant correlations between time perspective and both cyberbullying and cybervictimization. In particular, cybervictimization showed a quite large positive correlation with a past-negative orientation and a negative correlation with past-positive orientation. Instead, the involvement in active cyberbullying was positively correlated with a past-negative orientation and negatively correlated with future orientation. The findings advance the understanding of psychological factors influencing cyberbullying during early adolescence and suggest the importance of past-positive and past-negative orientations in accounting for both active cyberbullying and cybervictimization. As expected, future orientation appeared to represent a protective factor against involvement in cyberbullying behaviors.

Contact with migrants and perceived school climate as correlates of bullying toward migrants classmates.

This study investigates whether the quantity and quality of contact with migrants and perceiving that cultural diversity is accepted at school (as a dimension of the perceived school climate) are associated with perpetrating bullying toward migrant classmates. Quantity and quality of contact are also examined as moderators of the association between perceived cultural acceptance at school and bullying toward migrant students. One hundred and sixty-six adolescents (Mage = 16.26; SD = 1.53) belonging to the societal majority group answered a battery of self-report measures. Bullying migrant peers was associated with more negative quality of the contact. Bullying migrants was also associated with lower perceived acceptance of cultural diversity at school for the adolescents reporting higher levels of contact with migrants at school. The role of contact in explaining bullying toward migrant peers is also discussed in light of possible interventions.

Exploring Sex Differences in the Association between Bullying Involvement and Alcohol and Marijuana Use among U.S. Adolescents in 6th to 10th Grade.

Objectives: The aim of the current study was to examine whether different types of involvement in bullying, together with a set of social-ecological correlates, were associated with alcohol and marijuana use for female and male adolescents. Methods: This study utilized data derived from the U.S. division of the 2005-2006 Health Behavior in School-Aged Children (HBSC) study, which include 7,084 U.S. 6th-10th graders (3,353 males and 3,731 females) in public and private schools. Results: The results showed that although some forms of involvement in bullying were associated with alcohol and marijuana use, some of these associations became non-significant when the social-ecological covariates were included in the models. The final logistic regression models revealed that being a traditional bully-victim increased the risk of alcohol use for males while being a traditional bully and cyber victim increased the risk of alcohol use for females. In addition, being a cyberbully increased the risk of marijuana use for males. While parental monitoring decreased the risk, delinquent peers increased the risk of both alcohol and marijuana use for both sexes. Parent/guardian support decreased the risk of alcohol use for females. The likelihood of alcohol use and marijuana use increased with age for both sexes, while being an African American was linked with a lower risk of alcohol and marijuana use among males. Conclusions/Importance: Our findings demonstrate the importance of examining the link between bullying involvement and substance use, together with social-ecological correlates for female and male adolescents.

When the bullied peer is native-born vs. immigrant: A mixed-method study with a sample of native-born and immigrant adolescents.

An increasing number of immigrant students attend Italian schools, with the possibility of being involved in bullying episodes. A few studies have investigated this phenomenon, providing some evidence that immigrant students may face an increased risk of being bullied compared to native-born students. The present study adopted a mixed-method design, which may better detect the dynamics of bullying towards immigrant peers. Participants were 692 native-born and immigrant students (20.5% with immigrant background; 54.8% females) who filled in self-report measures about their bullying experiences, popularity, acceptance of diversity at school, and prejudice. Thirty-five pupils (54% with immigrant background) were also interviewed. Two hypothetical bullying scenarios were presented: one depicting a native-born victim and one depicting an immigrant victim. After each scenario, adolescents were encouraged to reason about the motives for bullying. Quantitative data showed that general bullying was associated with perceived popularity status among peers, while racial bullying was associated with prejudice but not peer status. The relevance of anti-immigrant prejudices in driving racial bullying emerged also from adolescents' interviews. The qualitative data indicated that among the reasons for bullying, adolescents mentioned a desire for dominance and popularity, in particular when the victim was non-immigrant. Findings suggest that, in addition to individual and peer group-related risk factors, prejudice also needs to be addressed in anti-bullying interventions aimed to counteract racial bullying.

Bullying bystander behaviors: The role of coping effectiveness and the moderating effect of gender.

Researchers have suggested that bystander behaviors and victim coping play an important role in counteracting the negative effects of bullying. The current study investigated the relationship between students' ratings of coping effectiveness when addressing bullying and their behaviors as bystanders when witnessing bullying. Surveys were administered in a Midwestern, suburban school district. Some associations between perceptions of coping effectiveness and bystander behavior supported our hypotheses (e.g., constructive coping associated with defending bystander behaviors, externalizing associated with pro-bullying behaviors). However, some findings did not support hypothesized relationships. For example, higher ratings of effectiveness for cognitive distancing as a coping strategy were associated with increased defending behaviors as a bystander. Gender moderated some of these relationships. Pro-bullying bystander behavior was associated with increased ratings of cognitive distancing and decreased reports of constructive coping effectiveness for girls. Implications for future research and practice are discussed.

Emotional challenges of medical students generate feelings of uncertainty.

OBJECTIVES: Health care students face many situations during their education that might be emotionally challenging. Students are confronted with illness, suffering, death, patient treatment dilemmas, and witnessing unprofessional behaviour on the part of health care professionals. Few studies have focused on what these experiences lead to in relation to the process of becoming a professional. The purpose of the study was to explore medical students' main concerns relating to emotionally challenging situations during their medical education. METHODS: A constructivist grounded theory approach was used to explore and analyse medical students' experiences. Data were gathered by means of focus group interviews, including two interviews in the middle and two interviews at the end of the students' undergraduate programme. A total of 14 medical students participated. RESULTS: Students' main concerns relating to emotionally challenging situations were feelings of uncertainty. These feelings of uncertainty concerned: (i) insufficient knowledge and skills; (ii) the struggle to manage emotions in patient encounters; (iii) perceived negative culture and values amongst health care professionals and in the health care system, and (iv) lacking a self-evident position on the health care team. The first two aspects relate to uncertainties concerning their own capabilities and the other two aspects relate to uncertainties regarding the detached medical culture and the unclear expectations of them as students in the health care team. CONCLUSIONS: In the process of becoming a physician, students develop their professional identity in constant negotiation with their own perceptions, values and norms and what they experience in the local clinical context in which they participate during workplace education. The two dimensions that students have to resolve during this process concern the questions: Do I have what it takes? Do I want to belong to this medical culture? Until these struggles are resolved, students are likely to experience worry about their future professional role.

Re-negotiating agency - patients using comics to reflect upon acting in situations of abuse in health care.

BACKGROUND: There is a growing body of international research that displays the prevalence and character of abuse in health care. Even though most of these studies are conducted from a patient perspective little is known about how patients conceptualize their agency in relation to such situations. This study aimed to explore how patients reason about their potential to act in abusive situations. METHODS: Qualitative interviews were conducted with thirteen patients in Sweden. Central in the interviews were three comics, inspired by Boal's Forum Theatre and part of an earlier online intervention study in which the informants had participated. Each comic showed a situation in which a patient feels abused, and on the opposite side were suggestions for how the patient could act in response. Informants were asked to reflect about situations of abuse and in specific upon the comics. We used the methodology of constructivist grounded theory throughout the study, including the analysis. RESULTS: It appeared that the informants constantly re-negotiated their and other patients' agency in relation to the specifics of the event, patients' and staff's responsibilities, and the patients' needs and values. This process questions views of agency as fixed and self-evident, and can be understood as part of changing discourses about patients' social role and possibilities to organize their care. Using a feminist theory of power we expected the informants to elicit instances of resistance to domination, which is central to the comics. While doing that, the informants also hinted at parallel stories of empowerment and less visible forms of agency in spite of domination. CONCLUSION: The current analysis showed different ways in which the informants constantly re-negotiated their agency in potentially abusive situations. Not only did the informants engage in reflections about immediate responses to these untoward situations, they also engaged in thoughts about strategies that could protect them and counteract abuse in health care over the long-term. This opens up for future research into ways patients organize their care and identify threats and barriers to the care they need, which could be valuable knowledge for care quality improvement.

Moral Disengagement of Pure Bullies and Bully/Victims: Shared and Distinct Mechanisms.

The vast majority of adolescents recognize that bullying is morally wrong, yet bullying remains a problem in secondary schools, indicating young people may disengage from their moral values to engage in bullying. But it is unclear whether the same mechanisms enabling moral disengagement are active for bully/victims (who both bully and are bullied) as for pure bullies (who are not targets of bullying). This study tested the hypotheses that mechanisms of moral disengagement, including blaming the victim and minimizing the impact of bullying, may operate differently in bully/victims compared to pure bullies. From a sample of 1895 students from grades 7-9 (50.6% female; 83.4% from English speaking homes), 1870 provided self-reports on bullying involvement and mechanisms of moral disengagement associated with bullying. Two cut-offs were compared for bullying involvement (as perpetrator and as target of bullying) during the previous school term: a conservative cut-off (every few weeks or more often) and a liberal cut-off (once-or-twice). Using the conservative cut-off, both pure bullies and bully/victims enlisted moral disengagement mechanisms to justify bullying more than did uninvolved students and pure victims, with no significant difference in scores on any of the moral disengagement scales between pure bullies and bully/victims. For the liberal cut-off, bully/victims reported lower overall moral disengagement scores than did pure bullies, and specifically less distortion of consequences, diffusion of responsibility, and euphemistic labeling. This study advances bullying research by extending the role of moral disengagement in bullying episodes beyond pure bullies to victims, both pure victims and bully/victims. Examination of specific moral disengagement mechanisms and the extent of involvement in bullying enabled a more nuanced differentiation between the bullying groups. These results will inform future interventions aimed at reducing the use of moral disengagement mechanisms that sustain bullying and victimization. Targeted interventions are needed to challenge specific moral disengagement mechanisms from the perspectives of pure bullies and bully/victims.

Getting angry matters: Going beyond perspective taking and empathic concern to understand bystanders' behavior in bullying.

The present study examined the relations between different empathic dimensions and bystanders' behavior in bullying. Specifically, the indirect effects of empathic concern and perspective taking via empathic anger on defending and passive bystanding were tested in a sample of Italian young adolescents (N = 398; Mage = 12 years, 3 months, 47.2% girls). Path analysis confirmed the direct and indirect effects, via empathic anger, of empathic concern and perspective taking on bystanders' behavior, with the exception of the direct association between perspective taking and passive bystanding that was not significant. Our findings suggest that considering empathic anger together with empathic concern and perspective taking could help researchers to better understand the links between empathic dispositions and bystanders' behavior in bullying.

Early adolescents' motivations to defend victims in school bullying and their perceptions of student-teacher relationships: A self-determination theory approach.

The aim of this study was to investigate whether various dimensions of student-teacher relationships were associated with different types of motivation to defend victims in bullying and to determine the association between these types of motivations and various bystander behaviors in bullying situations among early adolescents in Italy. Data were collected from 405 Italian adolescents who completed a survey in their classroom. Results showed that warm student-teacher relationships were positively associated with defending victims and with autonomous motivation to defend victims. In contrast, conflictual student-teacher relationships were positively associated with passive bystanding and with extrinsic motivation to defend victims. Different forms of motivation to defend were found to be mediators between student-teacher relationship qualities and bystander behaviors in school bullying. Our findings suggest that teachers should build warm and caring student-teacher relationships to enhance students' autonomous motivation to defend victims of bullying as well as their inclination to defend the victims in practice.

Understanding Ecological Factors Associated With Bullying Across the Elementary to Middle School Transition in the United States.

This study examines sociodemographic characteristics and social-environmental factors associated with bullying during the elementary to middle school transition from a sample of 5th-grade students (n = 300) in 3 elementary schools at Time 1. Of these, 237 participated at Time 2 as 6th-grade students. Using cluster analyses, we found groups of students who reported no increase in bullying, some decrease in bullying, and some increase in bullying. Students who reported increases in bullying also reported decreases in school belongingness and teacher affiliation and increases in teacher dissatisfaction. Students who reported decreases in bullying also reported decreases in victimization. These findings suggest that changes across the transition in students' relations to school and their teachers are predictive of changes in bullying.

School bullying and the mechanisms of moral disengagement.

The aim of the present study was to examine to what degree different mechanisms of moral disengagement were related to age, gender, bullying, and defending among school children. Three hundred and seventy-two Swedish children ranging in age from 10 to 14 years completed a questionnaire. Findings revealed that boys expressed significantly higher levels of moral justification, euphemistic labeling, diffusion of responsibility, distorting consequences, and victim attribution, as compared with girls. Whereas boys bullied others significantly more often than girls, age was unrelated to bullying. Moral justification and victim attribution were the only dimensions of moral disengagement that significantly related to bullying. Furthermore, younger children and girls were more likely to defend victims. Diffusion of responsibility and victim attribution were significantly and negatively related to defending, while the other dimensions of moral disengagement were unrelated to defending.