Medical student perceptions of gender and pain: a systematic review of the literature.

BACKGROUND: Gender bias exists in healthcare and affects how pain is assessed and managed. This bias affects patient outcomes and their trust in healthcare professionals. We also know that future clinicians develop their attitudes early in training. Medical school is therefore an opportunity to shape the values of future doctors and to combat systemic gender bias in healthcare. This systematic review aims to explore medical student perceptions of the relationship between patients' gender and their pain, so that recommendations can be made for developing medical education. METHODS: Embase, MEDLINE, PsychINFO, LILACS, Global Index Medicus, PakMediNet and ERIC were searched for articles relating to medical student perceptions of gender and pain, with no geographical or language limitations. Quality was assessed using the Medical Education Research Study Quality Index and the Critical Appraisal Skills Programme checklist. RESULTS: Nine publications were identified, two qualitative and seven quantitative. All studies had methodological limitations. Many different study designs were used, although most involved simulated patients. All studies referred to gender as binary. Multiple studies found that women's pain is more likely to be underestimated by medical students and that the patient's gender drives different approaches during clinical history taking, examination and management in these simulated situations. Only one study found no effect of patients' gender on students' perception of their pain. CONCLUSIONS: Whilst there is a paucity of high-quality studies in this area, patients' gender was found to affect how their pain is perceived by medical students. No studies explored where students' attitudes towards gender and pain arise from, and few involved 'real life situations'. We propose that further work into medical student perceptions in 'real situations' is needed. This will help to inform how undergraduate medical education can be developed to tackle gender bias, and ultimately improve outcomes for patients.

Crowdsourcing to increase hepatitis B and C testing and reduce hepatitis stigma among medical students in Bangladesh.

This study addresses the pervasive challenges of low hepatitis B (HBV) and hepatitis C (HCV) testing rates coupled with the stigma associated with these diseases in low- and middle-income countries (LMICs) with a special focus on Bangladesh. This study aims to introduce an innovative crowdsourcing intervention that involves medical students, a crucial cohort with the potential to shape healthcare attitudes. Through a structured crowdsourcing approach, the study designs and implements a digital intervention to counter stigma and promote testing among medical students in Dhaka, Bangladesh. Participants submitted brief videos or texts aiming to encourage hepatitis testing and reduce stigma. The call, advertised through meetings, emails, and social media, welcomed entries in English or Bengali over 3 weeks. A panel of six judges evaluated each entry based on clarity, impact potential, innovation, feasibility, and sustainability, awarding prizes to students behind the highest-rated submissions. Seventeen videos and four text messages received an average score of 5.5 among 440 surveyed medical students, predominantly 22 years old (16%) and in their fourth year (21%). After viewing, 360 students underwent screening, identifying two previously undiagnosed HBV cases referred for care; no HCV infections were found. Notably, 41% expressed concerns about individuals with HBV working in hospitals or having a doctor living with HBV. In conclusion, this pilot showcases the power of medical students in spearheading campaigns to counter hepatitis stigma and encourage testing. By utilizing crowdsourcing, the study introduces an innovative approach to a persistent issue in LMICs specially in Bangladesh, offering a model that could potentially be adapted by other regions grappling with similar challenges.

A Systematic Review of Ophthalmology Education in Medical Schools: The Global Decline.

TOPIC: This systematic review examined geographical and temporal trends in medical school ophthalmology education in relationship to course and student outcomes. CLINICAL RELEVANCE: Evidence suggesting a decline in ophthalmology teaching in medical schools is increasing, raising concern for the adequacy of eye knowledge across the rest of the medical profession. METHODS: Systematic review of Embase and SCOPUS, with inclusion of studies containing data on medical school ophthalmic course length; 1 or more outcome measures on student ophthalmology knowledge, skills, self-evaluation of knowledge or skills, or student course appraisal; or both. The systematic review was registered prospectively on the International Prospective Register of Systematic Reviews (identifier, CRD42022323865). Results were aggregated with outcome subgroup analysis and description in relationship to geographical and temporal trends. Descriptive statistics, including nonparametric correlations, were used to analyze data and trends. RESULTS: Systematic review yielded 4596 publication titles, of which 52 were included in the analysis, with data from 19 countries. Average course length ranged from 12.5 to 208.7 hours, with significant continental disparity among mean course lengths. Africa reported the longest average course length at 103.3 hours, and North America reported the shortest at 36.4 hours. On average, course lengths have been declining over the last 2 decades, from an average overall course length of 92.9 hours in the 2000s to 52.9 hours in the 2020s. Mean student self-evaluation of skills was 51.3%, and mean student self-evaluation of knowledge was 55.4%. Objective mean assessment mark of skills was 57.5% and that of knowledge was 71.7%, compared with an average pass mark of 66.7%. On average, 26.4% of students felt confident in their ophthalmology knowledge and 34.5% felt confident in their skills. DISCUSSION: Most evidence describes declining length of courses devoted to ophthalmology in the last 20 years, significant student dissatisfaction with courses and content, and suboptimal knowledge and confidence. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Medical students' reproductive health perspectives: Pre- and post-Roe v Wade reversal.

The ability to make informed decisions about reproductive health is a cornerstone principle of the practice of prenatal medical genetics. Unfortunately, these reproductive health decisions have become entangled in the current, contentious political climate. This debate reached an inflection point in 2022 with Dobbs v. Jackson when the Supreme Court of the United States (SCOTUS) overturned the national right to abortion previously established in Roe v. Wade. This decision prompted a reassessment of the opinions of medical students on reproductive health and abortion. Our study focused on a medical school in Alabama, a conservative state that enacted a restrictive abortion ban following the Dobbs ruling. Two surveys, conducted in 2015 and 2022, explored students' viewpoints on reproductive health topics, including abortion. The comparison revealed a significant shift toward more pro-choice perspectives among medical students. Notably, religious affiliation did not consistently align with opinions, as many Christian students supported pro-choice views. Our results suggest that medical students' reproductive health opinions at our institution have shifted to a more pro-choice position over the last decade.

The impact of simulation-based training on medical students' whole blood transfusion abilities.

BACKGROUND: Whole blood transfusion has been found to increase the likelihood of patient survival within both military and civilian medicine contexts. However, no whole blood transfusion training curriculum currently exists within undergraduate or graduate medical education in the United States. The purpose of our study was to: (1) determine the impact of simulation-based training on medical students' abilities to conduct whole blood transfusions; and (2) determine the impact of simulation-based training on medical students' confidence in conducting whole blood transfusions. STUDY DESIGN AND METHODS: We assessed 157 third-year military medical students' ability to conduct whole blood transfusion before and after Operation Gunpowder, a 2-day high-fidelity prolonged casualty care simulation. We conducted a paired samples t-test to compare the students' pre- and post-simulation performance scores as well as self-reported confidence and stress ratings. RESULTS: There was a significant difference in students' scores at the beginning of the course (M = 20.469, SD 6.40675) compared to their scores at the end of the course (M = 30.361, SD = 2.10053); t(155) = -18.833, p < .001. The effect size for this analysis (d = 6.56) was large. There was a significant difference (p < .001) between the pre- and post-ratings for all self-reported confidence and stress survey items. DISCUSSION: Our results suggest that simulation-based training is an effective means of training medical students to conduct whole blood transfusiontraining in a limited resource simulated environment where blood inventories may be limited.

The golden tickets: impact of preference signaling on obstetrics and gynecology residency applicants.

BACKGROUND: With the residency selection process becoming more competitive and programs receiving unprecedented numbers of applications, some specialties have introduced preference signaling in an attempt to help applicants target programs of interest. In the 2022-2023 application cycle, obstetrics and gynecology also introduced a 2-tiered system with a limited number of gold signals (n=3) and silver signals (n=15). OBJECTIVE: Given the novelty of preference signaling in the obstetrics and gynecology residency application process, this study aimed to (1) assess the effect of signals on interview offers and match and (2) discuss applicant attitudes toward this preference signaling system. STUDY DESIGN: This was a voluntary cross-sectional survey study conducted in April 2023 that was open to all fourth-year medical students who applied to an obstetrics and gynecology residency in the United States. Self-reported demographics, signaling, interview, and match data were collected. In addition, students were asked about attitudes toward signaling on a 5-point Likert scale. RESULTS: Of the 1507 applicants who entered an obstetrics and gynecology residency via match or Supplemental Offer and Acceptance Program process, 969 (64.3%) completed the survey. Moreover, an additional 22 applicants who did not match responded to the survey. More respondents used all 3 gold tokens (98.3%) and all 15 silver tokens (94.3%). The mean number of applications sent was 74.3±35.1, and the mean number of interviews received per applicant was 12.8±6.6. The interviews or token yields were 64.0%±31.5% for gold tokens, 43.8%±23.1% for silver tokens, and 9.8%±10.0% for no token. Of the survey respondents, 340/951 (35.8%) matched to a gold token program, 338/951 (35.5%) matched to a silver token program, and 244/951 (25.7%) matched to a nontoken program. Furthermore, 499/951 applicants (52.5%) reported feeling slightly positive or very positive about signaling. CONCLUSION: Most obstetrics and gynecology applicants in this survey participated in preference signaling. Gold and silver tokens were associated with high ratios of interview invitations compared with no token. However, the overall number of applications did not decrease in the 2022-2023 cycle, and only half of survey respondents reported feeling positive about the signaling process. These results can inform program directors and students about application number and strategy in upcoming cycles.

Relative validity of an intelligent ordering system to estimate dietary intake among university students from a medical school in Shanghai, China.

BACKGROUND: Dietary assessment methods have limitations in capturing real-time eating behaviour accurately. Equipped with automated dietary-data-collection capabilities, the "intelligent ordering system" (IOS) has potential applicability in obtaining long-term consecutive, relatively detailed on-campus dietary records among university students with little resource consumption. We investigated (1) the relative validity of IOS-derived nutrient/food intakes compared to those from the 7-day food diary (7DFD); (2) whether including a supplemental food frequency questionnaire (SFFQ) improves IOS accuracy; and (3) sex differences in IOS dietary intake estimation. METHODS: Medical students (n = 221; age = 22.2 ± 2.4 years; 38.5% male and 61.5% female) completed the 7DFD and SFFQ. During the consecutive 7-day survey period, students weighed and photographed each meal before and after consumption. Then, students reviewed their 3-month diet and completed the SFFQ, which includes eight underprovided school-canteen food items (e.g., dairy, fruits, nuts). Meanwhile, 9385 IOS dietary data entries were collected. We used Spearman coefficients and linear regression models to estimate the associations among the different dietary intake assessment methods. Individual- and group-level agreement was assessed using the Wilcoxon signed-rank test, cross-classification, and Bland‒Altman analysis. RESULTS: IOS mean daily energy, protein, fat, and carbohydrate intake estimations were significantly lower (-15-20%) than those of the 7DFD. The correlation coefficients varied from 0.52 (for added sugar) to 0.88 (for soybeans and nuts), with fruits (0.37) and dairy products (0.29) showing weaker correlations. Sixty-two (milk and dairy products) to 97% (soybeans and nuts) of participants were classified into the same or adjacent dietary intake distribution quartile using both methods. The energy and macronutrient intake differences between the IOS + SFFQ and 7DFD groups decreased substantially. The separate fruit intake measurements from each assessment method did not significantly differ from each other (p > 0.05). IOS and IOS + SFFQ regression models generally yielded higher R2 values for males than for females. CONCLUSION: Despite estimation differences, the IOS can be reliable for medical student dietary habit assessment. The SFFQ is useful for measuring consumption of foods that are typically unavailable in school cafeterias, improving the overall dietary evaluation accuracy. The IOS assessment was more accurate for males than for females.

A Qualitative Study Defining Perspectives on Rurality and Surgery From Midwestern Medical Schools.

INTRODUCTION: Rural general surgery faces a crisis as more surgeons undergo fellowship training and then practice in metropolitan areas, leaving rural Americans with decreasing surgical care. This study aims to identify how hometown rurality affects medical students' current level of knowledge and potential educational gaps within their understanding of the definition, benefits, and challenges of rural general surgery to define the need for enhanced education within medical schools. METHODS: In Spring 2021, 11 Midwestern medical schools participated in an electronic survey. Participants were divided into three groups (rural, urban, or suburban) based on their hometown rurality using Rural-Urban Continuum Codes. Qualitative analysis was performed for three questions addressing the definition, benefits, and challenges of rural surgery. RESULTS: Responses were analyzed from 411 students whose hometowns were representative of 33 states. The majority of respondents were female (n = 260; 63.4%) and Caucasian (n = 230; 56.9%) from self-reported suburban backgrounds who grew up and remained in the Midwest for their education. Major themes identified across all students were defining rural surgery as "Rural"/"Farmland"/"Nowhere" and specified the challenges of rural surgery to be relating to funding, facilities, and/or technology. Benefits identified were breadth of surgical procedures and community engagement. CONCLUSIONS: Most students do not understand the concept of rurality by definition or Rural-Urban Continuum Codes. However, students were able to identify a broad range of challenges and benefits faced by rural surgeons today. This provides a foundational needs assessment to drive future educational efforts to increase exposure to and knowledge of rural general surgery.

Scholarly Activity and Gender of an Applicant for a General Surgery Residency.

INTRODUCTION: Applying to general surgery residency is undoubtedly a competitive process. Participation in scholarly activity (SCA) has been cited as a criterion when selecting applicants for interview and in the ranking process. This study aims to evaluate the association between gender of applicants to surgery residency and SCA and to characterize trends in SCAs over time. METHODS: We analyzed the SCA of applicants interviewed at a general surgery residency program over 6-interview cycles (2016-2021). Eight SCA categories were included: (1) Poster Presentation, (2) Oral Presentation, (3) Peer-Reviewed (PR) Journal Articles/Abstracts, (4) PR Journal Articles/Abstracts (Other than Published), (5) PR Online Publication, (6) PR Book Chapter, (7) Nonpeer reviewed Online Publication, and (8) Other Articles/Scientific Monograph. RESULTS: Of a total of 335 interviewed applicants, 288 (86%) had at least one count of SCA. Overall, no difference between male and female applicants was noticed (n = 178, 84.8% versus n = 110, 88%, P = 0.409) and no change in percentage of SCA over the six cycles (P = 0.239). The most reported SCAs were poster presentations (n = 242, 72.2%), oral presentations (n = 159, 47.5%), PR journal articles/abstracts (n = 159, 47.5%). Female applicants have marginally higher median (interquartile range) for SCAs compared to male applicants (5 [3, 8] versus 4 [3, 8], P value 0.272). CONCLUSIONS: No association between gender and SCA among applicants for general surgery residency positions was observed. While more than three-fourths of applicants have at least one SCA, only a small fraction of applicants were published. Students should be made aware of the importance of SCA early in graduate medical education.

How to Create a Diversity, Equity, and Inclusion Curriculum: More Than Checking a Box.

We are beginning to accept and address the role that medicine as an institution played in legitimizing scientific racism and creating structural barriers to health equity. There is a call for greater emphasis in medical education on explaining our role in perpetuating health inequities and educating learners on how bias and racism lead to poor health outcomes for historically marginalized communities. Diversity, equity, and inclusion (DEI; also referred to as EDI) and antiracism are key parts of patient care and medical education as they empower health professionals to be advocates for their patients, leading to better health care outcomes and more culturally and socially humble health care professionals. The Liaison Committee on Medical Education has set forth standards to include structural competency and other equity principles in the medical curriculum, but medical schools are still struggling with how to specifically do so. Here, we highlight a stepwise approach to systematically developing and implementing medical educational curriculum content with a DEI and antiracism lens. This article serves as a blueprint to prepare institution leadership, medical faculty, staff, and learners in how to effectively begin or scale up their current DEI and antiracism curricular efforts.

Dietary habits as associated factors with irritable bowel syndrome among medical students: evidence from a cross-sectional study.

BACKGROUND: Research on Irritable Bowel Syndrome (IBS) among medical students has increased globally, highlighting a high prevalence in this demographic. However, there is a lack of data specifically regarding the prevalence of IBS among medical students in Yemen. This study aimed to investigate the prevalence and associated factors of IBS among Yemeni medical students. METHODS: We conducted a cross-sectional study involving medical students who completed a validated self-administered questionnaire incorporating socio-demographic information, dietary habits, smoking status, sleep patterns, and the Rome IV criteria for IBS. We used bivariate and multivariate logistic regression models to identify IBS's associated factors, estimated as odds ratios (ORs) with 95% confidence intervals (CIs) and average marginal effect (AME) on the predicted probability of IBS. RESULTS: The study included 351 medical students with a mean age of 22.53 ± 2.70 years; 39.60% (139) were females. The prevalence of IBS was 26.21% (92 students), with 67.39% (62) of them classified as IBS-M (mixed). In multivariable analysis, the consumption of carbonated soft drinks remained significantly associated with IBS (OR: 3.35; 95% CI: 1.14-9.88; P = 0.028). In males, coffee consumption had a substantial effect on the predicted probability of IBS (AME: 11.41%; 95% CI: 0.32-22.60). In females, the consumption of carbonated soft drinks had a significant effect on the predicted probability of IBS (AME: 24.91%; 95% CI: 8.34-41.48). CONCLUSION: The consumption of carbonated soft drinks is significantly associated with IBS among medical students, with a particularly notable increase in the predicted probability of IBS in females. These findings highlight the necessity for gender-specific dietary recommendations in IBS management. Further research is essential to investigate IBS in the general population to gain a comprehensive understanding of its prevalence and associated factors.

Knowledge Levels About Inflammatory Bowel Disease Vary Between Healthcare Professional Groups.

BACKGROUND: Inflammatory Bowel Disease (IBD) is one of the most serious chronic diseases affecting the global population. Clinical team members involved in the care of individuals with IBD should have sufficient knowledge about IBD. AIMS: The study aim was to assess IBD knowledge among four health care professional groups in New Zealand: nurses, medical students, dietitians, and pharmacists. METHODS: All four groups completed surveys on demographics, work experience, and contact with patients with IBD. All completed a validated IBD knowledge assessment questionnaire (IBD-KID2), and percentage scores with standard deviation (SD) for each group calculated and compared. RESULTS: Participants included 200 nurses, 196 medical students, 45 dietitians, and 28 pharmacists. Mean IBD-KID2 percentage scores were nurses 69.7% (SD 14.7), medical students 77.6% (SD 14.5), dietitians 87.4% (SD 8.3), and pharmacists 83.4% (SD 10.1). Nurses scored lower than other HCP (P < 0.001). Independent variables were associated (P < 0.05) with higher scores for nurses having first degree relative with IBD, access to IBD guidelines, worked with children with IBD; medical students in their clinical years of study; and dietitians with IBD-specific education. Specific items scored poorly: growth, food triggers, heritability of IBD, and nutrient absorption. CONCLUSIONS: Knowledge gaps exist among HCP that may be addressed with targeted education. Improvements in the knowledge of those caring for people with IBD may optimize patient outcomes.

Red Ribbon Club inculcation of positive deviance approach to promote blood donation among undergraduate medical college students.

BACKGROUND: Blood is an essential part of human life and blood donation has become a necessity that every society must take into consideration. Health care professionals have a major responsibility in raising community awareness on blood donation. OBJECTIVE: This study aims to find out the knowledge and attitude of undergraduate medical students on blood donation and to determine the effectiveness of positive deviance (PD) approach. METHODOLOGY: This institutional based cross-sectional study was conducted as a part of World AIDS Days celebration by Red Ribbon club among 414 undergraduate students using convenient sampling technique. A baseline and endline survey were conducted using a pre-structured validated questionnaire. To address the knowledge gap PD approach was used for the students who had voluntarily donated blood, volunteered in providing health education, and shared their experience to their peers. Ethical principals were adhered. RESULTS: The mean age of the students was 20.4 ± 1.2 years. Most respondents had moderate knowledge on blood donation and positivity attitude towards the same. The key finding of our study is that about 45 students (10.9%) have donated blood till now. As a result of PD training session more than half of them volunteered to donate blood in the future. CONCLUSION: This study shows that awareness about blood donation were minimal among the medical students with misconceptions. After PD approach, the willingness was increased from 10% to 66%. Thus, PD approach builds capacity and leadership in volunteers is considered as the best approach for behavior change among their own peers.

Empathy in undergraduate medical students: a multi-center cross-sectional study in China.

BACKGROUND: Fostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with medical students' academic and clinical performance. However, empathy level of medical students in China and related influencing factors are not clear. METHODS: This was a cross-sectional study among medical students in 11 universities. We used the Jefferson Scale of Empathy Student-version of Chinese version to measure empathy level of medical students. Factors associated with empathy were identified by the univariate and multivariate logistic regression analyses. Based on the variables identified above, the nomogram was established to predict high empathy probability of medical students. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate the discrimination, calibration and educational utility of the model. RESULTS: We received 10,901 samples, but a total of 10,576 samples could be used for further analysis (effective response rate of 97.02%). The mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39). Six variables including gender, university category, only child or not, self-perception doctor-patient relationship in hospitals, interest of medicine, Kolb learning style showed statistical significance with empathy of medical students (P < 0.05). Then, the nomogram was established based on six variables. The validation suggested the nomogram model was well calibrated and had good utility in education, as well as area under the curve of model prediction was 0.65. CONCLUSIONS: We identify factors influencing empathy of undergraduate medical students. Moreover, increasing manifest and hidden curriculums on cultivating empathy of medical students may be needed among medical universities or schools in China.

Prevalence and influencing factors of sleep disorders in medical students after the COVID-19 pandemic.

BACKGROUND: The prevalence of sleep disorders among medical students was high during the COVID-19 pandemic. However, fewer studies have been conducted on sleep disorders among medical students after the COVID-19 pandemic. This study investigated the prevalence and factors influencing sleep disorders among Chinese medical students after COVID-19. METHODS: A total of 1,194 Chinese medical students were included in this study from 9th to 12th July 2023. We used the Self-administered Chinese scale to collect the demographic characteristics. In addition, we used the Chinese versions of the Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) to assess subjects' depression, anxiety, and sleep disorders, respectively. The chi-square test and binary logistic regression were used to identify factors influencing sleep disorders. The receiver operating characteristic (ROC) curve was utilized to assess the predictive value of relevant variables for sleep disorders. RESULTS: We found the prevalence of sleep disorders among medical students after COVID-19 was 82.3%. According to logistic regression results, medical students with depression were 1.151 times more likely to have sleep disorders than those without depression (OR = 1.151, 95% CI 1.114 to 1.188). Doctoral students were 1.908 times more likely to have sleep disorders than graduate and undergraduate students (OR = 1.908, 95% CI 1.264 to 2.880). CONCLUSION: The prevalence of sleep disorders among medical students is high after COVID-19. In addition, high academic levels and depression are risk factors for sleep disorders. Therefore, medical colleges and administrators should pay more attention to sleep disorders in medical students after the COVID-19 pandemic. Regular assessment of sleep disorders and depression is essential.

A cross-sectional study on personal values of medical students: the differences from their instructors, their associations with mental wellbeing, and the influences of gender.

BACKGROUND: Personal values of Thai medical students have been observed to be diverging from those of their seniors, but the differences remain uncharacterized. Despite its potential association with mental wellbeing, the issue remain unexplored in the population. This study aimed to explore (1) the difference in personal values between medical students and instructors and (2) the association between student's value adherence to mental well-being and the interaction by gender. METHODS: An online survey was performed in 2022. Participants rated their adherence to five groups of values, namely, Self-Direction, Hedonism, Achievement & Power, Universalism & Benevolence, and Tradition. Participants also rated their mental wellbeing. Comparisons were made between the personal values of students and instructors. The association between the personal values of students and their mental wellbeing and the interaction between values and gender were analyzed in linear regression. RESULTS: Compared to instructors, students rated higher on Universalism & Benevolence, marginally higher on Hedonism, and lower on Tradition. Students' ratings on Self-Direction, Universalism & Benevolence, and Tradition predicted better mental wellbeing. Their rating on Hedonism predicted poorer mental wellbeing, the effect of which was marginally stronger in males. Ratings on Achievement & Power marginally predicted poorer mental wellbeing in females. CONCLUSION: Difference in personal values between medical students and instructors have been observed. Some of these values hold potentials over student's mental wellbeing. Curricular and medical school environmental accommodation for the changes in the characters of learners may be necessary to mitigate the adverse effects on their mental wellbeing and foster development of desirable professional characteristics.

Prevalence and correlates of generalized anxiety disorder and perceived stress among Sudanese medical students.

BACKGROUND: Generalized Anxiety Disorder (GAD) causes significant disturbance in an individual's well-being and activity. Whereby, interfering with the dynamic progress in life. Also, anxiety is a product of stress and a major predictor of academic performance. This study aimed to assess the prevalence of Generalized Anxiety Disorder (GAD), measure levels of anxiety and perceived stress, evaluate the academic profile, identify lifestyle characteristics, and explore the relationship between these factors. METHODS: In this cross-sectional study, 340 Sudanese medical students filled out online questionnaires, composed of the sociodemographic and lifestyle characteristics, academic profile, Generalized Anxiety Disorder-2 scale (GAD-2), and Perceived Stress Scale-10 (PSS-10). Descriptive and inferential statistics were applied using Statistical Package for Social Science (SPSS) Version 20.0 for data analysis. RESULTS: Of 340 medical students, 3.8% of them were diagnosed with GAD, while 29.1% scored ≥ 3 in GAD-2, indicating a possible diagnosis. The study found that 9.7% of the participants used addictive substances, with 42% of them having high GAD-2 scores. Moreover, high anxiety levels were associated with high-stress scores (p-value = 0.000). Also, high GAD-2 scores were significantly associated with students who spent less than 10,000 SDG (18 USD) weekly, spent more time on entertainment using smart devices (p-value = 0.004), and had an unhealthy diet (p-value = 0.004). Low anxiety levels were associated with better sleep quality (p-value = 0.00), satisfaction with religious practices (p-value = 0.00), and increased leisure/hobby time (p-value = 0.018). High-stress levels were observed in females (p-value = 0.035), those with lower academic performance satisfaction levels, and increased hours of smart device usage for entertainment (p-value = 0.001). Reduced stress levels were associated with being ≥ 23 years old, increased leisure/hobby time (p-value = 0.002), satisfaction with religious practices [F(3, 166.6) = 10.8, p-value = 0.00)], and having a healthy diet (p-value = 0.006). CONCLUSION: The low prevalence of GAD corresponded with previous literature, but 29.1% of medical students had a high probability of having GAD. The study emphasizes on providing accessible mental health services for medical students and interventions addressing modifiable risk factors.

Mental health disturbance in preclinical medical students and its association with screen time, sleep quality, and depression during the COVID-19 pandemic.

BACKGROUND: Affected by various hurdles during COVID-19, preclinical medical students are at an elevated risk for mental health disturbances. However, the effects of modern mental health problems on preclinical medical students have not been adequately researched. Thus, this study was aimed to identify the proportions and implications of current mental health problems for depression, sleep quality and screen time among Indonesian medical preclinical students during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted using crowdsourcing between October 2020 and June 2021. During the study period, 1,335 subjects were recruited, and 1,023 datasets were identified as valid. General Health Questionnaire-12 (GHQ-12) was used to measure current mental health disturbances (categorized as without current mental health disturbances, psychological distress, social dysfunction, or both). The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality, and a questionnaire devised for this study was used to assess screen time length per day. Multivariate data analysis was conducted using SPSS version 24 for Mac. RESULTS: According to the findings, 49.1% of the 1,023 participants had current mental health disturbances: 12.8% had psychological distress, 15.9% had social dysfunction, and the rest (20.4%) had both psychological distress and social dysfunction. The statistical analysis provided strong evidence of a difference (p < 0.001) between the medians of depression and sleep quality with at least one pair of current mental health disturbance groups, but the difference for screen time was not significant (p = 0.151). Dunn's post-hoc analysis showed that groups without current mental health problems had significantly lower mean ranks of depression and sleep quality compared to groups that had current mental health problems (p < 0.001). CONCLUSION: Current mental health disturbances during the COVID-19 pandemic were significantly associated with preclinical medical students' depression and sleep quality in preclinical medical students. Thus, mental health programs for this specific population should be tailored to integrate mindfulness therapy, support groups, stress management, and skills training to promote mental wellbeing.

Factors influencing stress and resilience among Egyptian medical students: a multi-centric cross-sectional study.

BACKGROUND: Psychological stress is a common psychological comorbidity among medical students and worsens their quality of life. Psychological resilience is thought to have a protective role against stress. However, evidence regarding the prevalence of stress and resilience alongside their associated factors is scarce, especially in the Middle East. This is the first multicenter, cross-sectional study to investigate resilience and stress among Egyptian medical students. METHODS: The current cross-sectional study was conducted on 2465 university students in seven public universities in Egypt. The universities were selected using the simple randomization method. The data was collected using a self-administered questionnaire consisting of four parts: demographic data, socioeconomic tool represented in the Family Affluence Scale (FAS), the Kessler Psychological Distress Scale (K10), and the Brief Resilience Scale (BRS). Data was analyzed in SPSS version 26 software. RESULTS: The majority of the students were stressed (86.5%), most of whom had severe stress (48.9%). Most of the students had low resilience (49.9%), while only 3.2% had high resilience. In the logistic regression analysis, being a female, living alone, spending long hours on social media, and thinking of suicide or leaving medicine were associated with being stressed and having low resilience. Medical students with low resilience were significantly more liable to stress [Adjusted odds ratio (AOR) = 3.667, confidence interval (CI): 2.709-4.965, P = 0.000], and vice versa [AOR = 3.709, CI: 2.746-5.009, P = 0.000]. Interestingly, high socioeconomic status showed a significant association with high resilience (P = 0.004); nonetheless, it was not associated with stress (P = 0.993). Academic grades were not associated with both the level of stress and resilience. Aging, being in clinical or academic stages, smoking, having a chronic disease, and being financially-supported are neither associated with stress nor resilience. CONCLUSIONS: The present study revealed that Egyptian medical students had low resilience and high stress, with a significant relationship between both of them. Further investigations via longitudinal study design to understand the resilience-stress relationship are recommended. Developing and implementing resilience-improving strategies in medical schools is highly recommended to decrease the prevalence of stress and its subsequent burdens.

Interventions to attract medical students to a career in primary health care services in the European Union and peripheral countries: a scoping review.

BACKGROUND: In the European Union and peripheral countries, the availability of physicians working in primary health care services (PHCS) varies greatly and all countries report shortages and difficulties in recruiting more. The broad consensus that giving access to PHCS to all is a policy priority, reinforced by the lessons learned during the COVID-19 pandemic, implies that a sufficient fit-for-purpose workforce is available. This article focuses on physicians and reports on what countries have done, and with what success, to attract more medical students to a career in PHCS. METHODS: We conducted a scoping review of articles in PubMed and Cochrane Library, and of grey literature in websites of international agencies, think-tanks, international non-governmental organizations, and European Commission-funded projects, published between January 2018 and February 2024. RESULTS: The search retrieved 1,143 records, of which 45 were eligible for the scoping review; 25 focused on medical students. The documents report interventions in 12 countries, 14 by individual education institutions, mostly in the form of exposure of diverse duration to general/family practice in the medical curriculum (specific modules, residencies, rotations, placements, mentorship), and 11 policy interventions at national level, such as increases in the number of training places for primary health care (PHC) specialties and improvement of working conditions. CONCLUSION: Accessible PHCS require the availability of a fit-for-purpose workforce of multiprofessional teams, in which specially trained physicians play a central role. To address shortages, many countries increased training opportunities, a necessary step, but not sufficient. More students must accept to opt for a PHC specialty, in a context of competition with other fields of practice also in need of more students, such as public health, geriatrics, or mental health. Success requires the collaboration of numerous actors, including professional councils and organizations, and regulation bodies that specialists tend to dominate. By making PHCS a political and policy priority, decision-makers can help make attraction more effective, but to do so, they need access to convincing evidence and information on good practices that only research can produce.