The efficacy of medical student selection tools in Australia and New Zealand.

OBJECTIVES: To estimate the efficacy of selection tools employed by medical schools for predicting the binary outcomes of completing or not completing medical training and passing or failing a key examination; to investigate the potential usefulness of selection algorithms that do not allow low scores on one tool to be compensated by higher scores on other tools. DESIGN, SETTING AND PARTICIPANTS: Data from four consecutive cohorts of students (3378 students, enrolled 2007-2010) in five undergraduate medical schools in Australia and New Zealand were analysed. Predictor variables were student scores on selection tools: prior academic achievement, Undergraduate Medicine and Health Sciences Admission Test (UMAT), and selection interview. Outcome variables were graduation from the program in a timely fashion, or passing the final clinical skills assessment at the first attempt. MAIN OUTCOME MEASURES: Optimal selection cut-scores determined by discriminant function analysis for each selection tool at each school; efficacy of different selection algorithms for predicting student outcomes. RESULTS: For both outcomes, the cut-scores for prior academic achievement had the greatest predictive value, with medium to very large effect sizes (0.44-1.22) at all five schools. UMAT scores and selection interviews had smaller effect sizes (0.00-0.60). Meeting one or more cut-scores was associated with a significantly greater likelihood of timely graduation in some schools but not in others. CONCLUSIONS: An optimal cut-score can be estimated for a selection tool used for predicting an important program outcome. A "sufficient evidence" selection algorithm, founded on a non-compensatory model, is feasible, and may be useful for some schools.

The art of communication.

BACKGROUND: Effective communication is an essential skill in general practice consultations. The art of communication is the development of effective skills and finding a style of communication that suits the clinician and produces benefits for both patient and doctor. OBJECTIVE: This paper outlines the essential skills required for effective communication with a patient and suggests that clinicians consider this communication as an art that can be developed throughout a medical career. DISCUSSION: Good communication can improve outcomes for patients and doctors, and deserves equal importance as developing clinical knowledge and procedural skill. The importance of good communication is so critical that Australian guidelines list effective communication as part of the required conduct for all doctors. A therapeutic patient-doctor relationship uses the clinician as a therapeutic intervention and is part of the art of communication. Despite all the technological advances of recent decades, caring, compassionate, healing doctors remain the best therapeutic tool in medicine. The ability of a doctor to provide comfort through their presence and their words is a fundamental component of good medical care.

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels.

OBJECTIVE: This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students. METHODS: We carried out a multicentre, single-blinded, randomised controlled trial with intention-to-treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block-randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self-report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow-up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS). RESULTS: Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age-matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (- 3.44, 95% confidence interval [CI] - 6.20 to - 0.68; p < 0.05) and the anxiety component of the DASS (- 2.82, 95% CI - 4.99 to - 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (- 3.69, 95% CI - 7.38 to 0.01; p = 0.05). Follow-up at 8 weeks post-trial revealed that the effect was maintained. CONCLUSIONS: Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self-administered, evidence-based intervention now exists to manage stress in this at-risk population and should be widely utilised.

What works? Evidence for lifestyle and nonprescription therapies in menopause.

BACKGROUND: Effective prescription medications are available to treat menopausal symptoms. However, due to adverse effects and risks associated with use, many women are seeking complementary and alternative options to treat their symptoms. Nonpharmacological options for the management of menopausal symptoms are widely available and frequently used. OBJECTIVE: This article outlines the use of, and evidence for, nonprescription therapies and complementary therapies for menopausal symptom management. DISCUSSION: There are a large number of studies on complementary and alternative therapies for the management of menopausal symptoms. Lifestyle changes are beneficial and studies on relaxation training are revealing encouraging results. Studies of the benefits of yoga have mixed results. Current evidence from systematic reviews does not support the use of over-the-counter complementary therapies or acupuncture. A large placebo effect exists for the management of hot flushes, therefore further research against active controls is required. Management options should be collaboratively explored.

A randomized controlled trial of the effects of mindfulness practice on doctoral candidate psychological status.

Objectives: To examine the impact of guided mindfulness practice on psychological distress and psychological capital (hope, optimism, resilience, and efficacy) in doctoral candidates. Participants: Recruitment of a convenience sample of doctoral candidates occurred in July 2015 and participants were randomly allocated to the control or intervention group (38 and 34 participants completed the trial, respectively). Methods: A single-blinded, randomized controlled trial with intention-to-treat analysis was conducted. The intervention consisted of a daily guided mindfulness practice, using an audio CD. Indicators of psychological distress and psychological capital were measured pre- and post-trial with validated questionnaires. Results: Compared to the control group, the intervention group reported a statistically significantly reduction in depression (p = .045) and increased self-efficacy (p = .004), hope (p = .000), and resilience (p = .011). Conclusions: These results highlight the effectiveness of self-administered mindfulness practice on the psychological health of doctoral candidates, and the positive effect on psychological capital is reported as a key finding.